2018 Volume 111 Issue 10 Pages 687-692
Radiation therapy is one of multidisciplinary approaches used for the treatment of head and neck cancers, but it can lead to undesirable complications because of the close proximity of radiosensitive structures to the head and neck. These complications include pseudoaneurysm of the carotid artery. Although rupture of a carotid artery pseudoaneurysm is a rare complication, it is a life-threatening event with a high rate of mortality and morbidity, that requires emergency treatment. Endovascular packing of the pseudoaneurysm using coils, glue, or covered stents is associated with a higher success rate, in terms of immediate hemostasis, than surgical ligation of the common carotid artery or extracranial-to-intracranial bypass.
Herein, we report a patient with pharyngeal cancer who developed a carotid artery pseudoaneurysm after radiation therapy plus total pharyngolaryngoesophagectomy. The pseudoaneurysm was first recognized 16 years after the initial therapy, and endovascular packing was performed using coils and a bare stent. Three years later, the patient presented with rupture of the common carotid artery pseudoaneurysm into the free jejunum. Hemostasis was accomplished by emergency endovascular treatment, however, the patient died within a short time thereafter, of cerebral infarction.
It is necessary to promote awareness about this complication as well as to establish management strategies for carotid blowout syndrome post radiotherapy, as the likelihood of occurrence of this complication is likely to rise with the improved prognosis of head and neck cancer patients.
