Prognosis of patients with carotid blowout syndrome in the era of endovascular interventions.

Overview

OBJECTIVE: To analyse the prognosis of carotid blowout syndrome (CBS) after endovascular interventions in patients with head and neck cancer. METHODS: We conducted a retrospective study at a tertiary centre (2000-2019), including demographics, medical history, treatment details, and outcomes of CBS. RESULTS: Among 44 patients with CBS (32 males, 12 females; mean age 65 ± 14 years), squamous cell carcinoma histotype and laryngeal localisation were most common, with 84% having advanced-staged disease. Significant risk factors included prior surgery (70%), neck dissection (48%), radiation (55%), and chemotherapy (66%). Pharyngocutaneous fistula and tracheostomy were present in 32% and 57% of cases, respectively. Radiological findings showed threatened bleeding (62%), sentinel bleeding (11%), and acute rupture (27%). Endovascular treatment achieved haemostasis in 95% of cases, with an 11% rate of acute ischaemic complications. Six-month survival was 28%, with 66% of deaths due to disease progression. Recurrent bleeding occurred in 16% of cases. CONCLUSIONS: CBS is a severe complication with a high risk of rebleeding. Endovascular interventions effectively manage bleeding with low rates of complication.