Hostname: page-component-6766d58669-l4t7p Total loading time: 0 Render date: 2026-05-19T10:51:05.877Z Has data issue: false hasContentIssue false
  • English
  • Français

Delayed carotid blow-out syndrome: a new complication of chemoradiotherapy treatment in pharyngolaryngeal carcinoma

Published online by Cambridge University Press:  11 September 2012

E Esteller ,
X León ,
M de Juan  and
M Quer
E Esteller
Affiliation:
Otorhinolaryngology Department, Hospital General de Catalunya, Spain
X León*
Affiliation:
Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau (Universitat Autònoma de Barcelona), Barcelona, Spain
M de Juan
Affiliation:
Department of Radiodiagnosis, Hospital de la Santa Creu i Sant Pau (Universitat Autònoma de Barcelona), Barcelona, Spain
M Quer
Affiliation:
Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau (Universitat Autònoma de Barcelona), Barcelona, Spain
*
Address for correspondence: Dr Xavier León, Otorhinolaryngology Department, Hospital de Sant Pau, Avda San Antoni Ma Claret 167, 08025 Barcelona, Spain Fax: +34 93 556 56 04 E-mail: xleon@santpau.cat
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Carotid blow-out syndrome is one of the most devastating complications of head and neck carcinoma. It usually occurs as a post-operative complication or when the tumour compromises the vascular axis.

Methods and results:

We report two patients who suffered carotid blow-out syndrome but who did not have the usual predisposing factors. Both patients had a pharyngolaryngeal carcinoma that was treated with chemoradiotherapy. Residual non-tumoural ulceration was seen along the lateral wall of the hypopharynx in both cases. This ulceration eventually reached the vascular axis, precipitating carotid rupture and death.

Conclusion:

Residual non-tumoural ulceration of the lateral wall of the hypopharynx after chemoradiotherapy should be considered with the utmost caution. Once persistence of the tumour is excluded, surgery is indicated to protect the vascular axis, in order to prevent carotid blow-out syndrome.

Keywords

Carotid Artery DiseasesLarynxPharynxCarcinomaComplicationChemoradiotherapy

Information

Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 11 , November 2012 , pp. 1189 - 1191
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1 Roh, JL, Suh, DC, Kim, MR, Lee, JH, Choi, JW, Choi, SH et al. Endovascular management of carotid blowout syndrome in patients with head and neck cancers. Oral Oncol 2008;44:844–50CrossRefGoogle ScholarPubMed
2 Chaloupka, JC, Putman, CM, Citardi, MJ, Ross, DA, Sasaki, CT. Endovascular therapy for the carotid blowout syndrome in head and neck surgical patients: diagnostic and managerial considerations. AJNR Am J Neuroradiol 1996;17:843–52Google ScholarPubMed
3 Citardi, MJ, Chaloupka, JC, Son, YH, Ariyan, S, Sasaki, CT. Management of carotid artery rupture by monitored endovascular therapeutic occlusion (1988–1994). Laryngoscope 1995;105:1086–92CrossRefGoogle ScholarPubMed
4 Koutsimpelas, D, Pitton, M, Külkens, C, Lippert, BM, Mann, WJ. Endovascular carotid reconstruction in palliative head and neck cancer patients with threatened carotid blowout presents a beneficial supportive care measure. J Palliat Med 2008;11:784–9Google ScholarPubMed
5 Upile, T, Triaridis, S, Kirkland, P, Archer, D, Searle, A, Irving, C et al. The management of carotid artery rupture. Eur Arch Otorhinolaryngol 2005;262:555–60CrossRefGoogle ScholarPubMed
6 Chang, FC, Lirng, JF, Luo, CB, Wang, SJ, Wu, HM, Guo, WY et al. Patients with head and neck cancers and associated postirradiated carotid blowout syndrome: endovascular therapeutic methods and outcomes. J Vasc Surg 2008;47:936–45CrossRefGoogle ScholarPubMed
7 Lesley, WS, Chaloupka, JC, Weigele, JB, Mangla, S, Dogar, MA. Preliminary experience with endovascular reconstruction for the management of carotid blowout syndrome. AJNR Am J Neuroradiol 2003;24:975–81Google ScholarPubMed
8 Temam, S, Pape, E, Janot, F, Wibault, P, Julieron, M, Lusinchi, A et al. Salvage surgery after failure of very accelerated radiotherapy in advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2005;62:1078–83CrossRefGoogle ScholarPubMed
9 Maruyama, Y, Arai, K, Hoshida, S, Yoneda, K, Furukawa, M, Yoshizaki, T. Case of three delayed complications of radiotherapy: bilateral vocal cord immobility, esophageal obstruction and ruptured pseudoaneurysm of carotid artery. Auris Nasus Larynx 2009;36:505–8CrossRefGoogle ScholarPubMed
10 Okamura, HO, Kamiyama, R, Takiguchi, Y, Kimizuka, K, Ishikawa, N, Kishimoto, S. Histopathological examination of ruptured carotid artery after irradiation. ORL J Otorhinolaryngol Relat Spec 2002;64:226–8CrossRefGoogle ScholarPubMed
11 Luo, CB, Teng, MM, Chang, FC. Radiation acute carotid blowout syndromes of the ascending pharyngeal and internal carotid arteries in nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2006;263:644–6CrossRefGoogle ScholarPubMed
12 Maran, AG, Amin, M, Wilson, JA. Radical neck dissection: a 19-year experience. J Laryngol Otol 1989;103:760–4CrossRefGoogle ScholarPubMed
13 Lam, HC, Abdullah, VJ, Wormald, PJ, Van Hasselt, CA. Internal carotid artery hemorrhage after irradiation and osteoradionecrosis of the skull base. Otolaryngol Head Neck Surg 2001;125:522–7CrossRefGoogle ScholarPubMed
14 Cheng, KY, Lee, KW, Chiang, FY, Ho, KY, Kuo, WR. Rupture of radiation-induced internal carotid artery pseudoaneurysm in a patient with nasopharyngeal carcinoma – spontaneous occlusion of carotid artery due to long-term embolizing performance. Head Neck 2008;30:1132–5CrossRefGoogle Scholar
15 Pathak, KA, Viallet, NR, Nason, RW. Sternocleidomastoid muscle interposition to prevent carotid artery blowout. J Surg Oncol 2008;98:565–6CrossRefGoogle ScholarPubMed