Endovascular Management of Carotid Blowout
Endovascular Management of Carotid Blowout
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DOI：
10.1016/j.wneu.2011.08.024
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发表时间：
2012-07-01
影响因子：
2
通讯作者：
Jabbour, Pascal
中科院分区：
文献类型：
--
作者：
Zussman, Benjamin;Gonzalez, L. Fernando;Jabbour, Pascal
目的：强调颈动脉破裂或颈动脉破裂综合征(CBS)的急诊血管内治疗的相关问题。CBS是头颈癌的一种危及生命的急诊并发症及其治疗。结果：8例患者，女性3例，男性5例，年龄47~78岁，平均61岁。7名患者有颈部鳞状细胞癌阳性病史，5名患者有活动性恶性疾病。采用液体栓塞剂、栓塞剂或两者同时使用均可立即止血，止血率均为100%。无一例因首次出血而死亡，但有1例在术后第1天发生致命性出血。两名患者出现了非致命性的术后并发症。平均随访3个月(1~8个月)，3例存活，3例死于基础疾病，2例死于其他原因。结论：晚期恶性疾病和CBS的治疗应提供最大限度的缓解，将再次手术的风险、发病率和死亡率降至最低。采用解构技术血管内治疗CBS，可实现即刻止血和明确治疗。术中死亡和再出血的风险很低。
OBJECTIVE: To highlight pertinent aspects of emergent endovascular management of carotid rupture, or carotid blowout syndrome (CBS), an emergent, life-threatening complication of head and neck cancer and its treatments.METHODS: A retrospective chart review was conducted of all patients with carotid blowouts at the authors' institution from 2008-2010. A systematic literature review was also performed.RESULTS: Eight patients (three women and five men) with an average age of 61 years (range 47-78 years) were reviewed. Seven patients had a positive history for squamous cell carcinoma of the neck, and five patients had active malignant disease. Carotid arterial deconstruction using liquid embolic material, coil embolization, or both achieved immediate hemostasis in every case (100%). No patients died as a result of their initial hemorrhage, but one patient had lethal hemorrhage at 1 day postoperatively. Two patients experienced nonlethal postoperative complications. At an average follow-up of 3 months (range < 1-8 months), three patients were alive, three had died as a result of their underlying disease, and two had died of other causes.CONCLUSIONS: The treatment of patients with terminal malignant disease and CBS should provide maximum relief and minimize the risks of repeat surgery, morbidity, and mortality. Endovascular management of CBS with deconstructive techniques achieves immediate hemostasis and definitive treatment. The risks of intraoperative mortality and recurrent hemorrhage are low.