Delayed carotid artery rupture in advanced cervical cancer – a dilemma in emergency management

Abstract

Carotid artery rupture in the setting of advanced carcinoma of the head and neck constitutes a surgical emergency. This report details three such patients, two of whom presented with profuse bleeding, the other with imminent rupture. Notably, our first patient ruptured 27 years after having had radiotherapy for carcinoma of the larynx. This patient had had no previous surgery and at operation no recurrent tumor was evident. In the other two patients, previous surgery had demonstrated tumor invasion of the carotid artery. The choice of therapy in this calamitous condition is controversial, the question being whether to resect and reconstruct or ligate the ruptured artery. Our three patients underwent ligation with no recurrence of bleeding and no neurological sequelae for a follow-up period of 5-36 months. Of paramount importance is the hemodynamic stabilization of the patient prior to being submitted to surgery. Our results favor ligation rather than resection and reconstruction as the procedure of choice in this difficult predicament.

Transcutaneous arterial embolization to control massive tumor bleeding in head and neck cancer: 63 patients’ experiences from a single medical center

“…Massive tumor bleeding in patients with HNC is a difficult management problem. Surgical ligation of the carotid artery was reported as an approach to manage a massive, life-threatening hemorrhage [16,17]. This technique carried a relatively high mortality rate, with a risk of hemiplegia and tumor rebleeding, due to backflow from collateral circulation.…”

Management of Bleeding in Patients with Advanced Cancer

“…Surgery usually consists of ligation of larger vessels [69] or the removal of bleeding tissue [70]. Two surgical approaches have been described for the management of carotid artery rupture: resection with reconstruction and ligation of the artery.…”

“…Two surgical approaches have been described for the management of carotid artery rupture: resection with reconstruction and ligation of the artery. Witz et al reported on three patients with head and neck cancers who presented with acute or imminent carotid artery rupture [69]. Those patients successfully underwent ligation of the artery with no neurological sequelae.…”

Kraniale und zervikale arterielle Gefäßverletzungen: Bildgebung und Therapie

“…Bei geringen Blutungen kann es bei gleichzeitiger Infusionstherapie zur Blutverdünnung mit Verminderung der Hämoglobinkonzen-tration und des Hämatokrit kommen. Bei stärkeren Blutungen zeigen die Patienten die Zeichen des Volumenmangels, die z. T. erhebliche intensivmedizinische Therapie erfordert [16].…”

“…Bei starken Blutungen ist der Patient meist intubiert, und in dieser Notfallsituation benötigt er erhebliche intensivmedizinische Therapie [16]. Auf traumatische A. carotis Sinus-cavernosusFisteln wird unten ausführlicher eingegangen.…”