Endovascular Palliation of Multivessel Blowout Syndrome in the Setting of a Nonresectable Neck Sarcoma

Nassiri, Naiem; Kapoor, R; Vitek, Jiri J.; Rosen, Robert J.; Moutran, Homere Al; Costantino, Peter D.; Green, Richard M.

doi:10.1016/j.avsg.2012.05.003

Cited by 8 publications

(10 citation statements)

References 10 publications

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“…[1][2][3] The emergence of endovascular treatments such as parent artery occlusion and covered stents has resulted in markedly improved outcomes. 3,[5][6][7][8][9][10][11][12][13][14] However, since this condition is relatively uncommon, available information about outcomes and treatment modalities is based only on small single center series. Using the Nationwide Inpatient Sample (NIS), we report the immediate clinical results of patients receiving embolization and/or stenting for treatment of carotid blowout associated with head and neck cancer.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout

Brinjikji

Cloft

2015

Interv Neuroradiol

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Background and purpose Carotid blowout is a life threatening complication of invasive head and neck cancers and their treatments. This is commonly treated with endovascular embolization and carotid stenting. Using the Nationwide Inpatient Sample, we report the immediate clinical results of patients receiving embolization and/or stenting for treatment of carotid blowout associated with head and neck cancer. Materials and methods Using the Nationwide Inpatient Sample from the period 2003–2011, we defined carotid blowout patients as those with head and neck malignancies receiving carotid stenting and/or endovascular embolization without open surgery. Outcomes studied included mortality, acute ischemic stroke, hemiplegia/paresis, and other post-operative neurologic complications. Outcomes for the endovascular embolization and carotid stenting group were compared. Results A total of 1218 patients underwent endovascular treatment for carotid blowout. Of these, 1080 patients (88.6%) underwent embolization procedures and 138 patients (11.4%) underwent carotid stenting. The mortality rate of endovascular embolization patients was similar to that of carotid stenting patients (8.0%, 95% confidence interval (CI) = 6.5%–9.7% versus 10.2%, 95% CI=6.0%–16.4%, p = 0.36). Stroke rate was similar between embolization patients and stenting patients (2.3%, 95% CI=1.6%–3.4% vs. 3.4%, 95% CI=1.3%–8.4%, p = 0.43). Hemiplegia rates were significantly higher rate in stenting patients compared with endovascular occlusion patients (3.8%, 95% CI=1.3%–8.4% vs. 1.4%, 95% CI=1.4%–2.4%, p = 0.05). The rate of post-operative neurologic complications was higher in stenting patients compared with embolization patients (6.5%, 95% CI=3.3%–12.1% vs. 1.4%, 95% CI=0.9%–2.4%, p < 0.0001). Conclusions Given the natural history of carotid blowout, carotid stenting and endovascular embolization are acceptable means of treating this disease. Endovascular embolization remains the most common treatment among patients with head and neck cancers with lower overall rates of post-operative neurologic complications, including hemiplegia/paresis and stroke.

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Section: Introductionmentioning

confidence: 99%

Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout

Brinjikji

Cloft

2015

Interv Neuroradiol

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“…1 Endovascular procedures such as super-selective transarterial embolization and refined stenting techniques offer durable life-saving option for such cases. 1 –5 Management has been predominantly surgical and comprised of vascular reconstruction with either interposition or bypass grafting using autogenous or synthetic graft with or without flap coverage. 4 Joshi et al reported a case of internal iliac artery blow out secondary to radiotherapy for advanced rectal cancer that was treated successfully by left axaillofemoral bypass graft after complicated endovascular intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular management for VBOS can offer an effective, low risk, and minimally invasive treatment of life-threatening bleeding and resulting peripheral ischemia; furthermore; it can serve as an important prophylactic option in threatened and impending blowout. 3,7,9 Previous reports include endovascular management of peripheral VBOS secondary to scrotal, vulvar cancers, basal cell carcinoma, and retroperitoneal sarcomas. [7][8][9][10] Huntress et al presented successful covered stent revascularization for an impending blowout of the left iliac artery with ipsilateral limb ischemia secondary to retroperitoneal sarcoma.…”

Section: Discussionmentioning

confidence: 99%

“…Vascular blowout syndrome (VBOS) is a well-recognized condition most commonly reported in advanced head and neck malignant neoplasms adjacent to the cervical carotid circulation. 1 –5 Depending on the extent of tumor invasion, VBOS is classified into 3 categories: threatened is defined as vessel encased by a tumor, impending describes bleeds that can be managed by nonoperative conservative measures, and acute vascular blowout includes cases with massive life-threatening hemorrhage. 2,3…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] Depending on the extent of tumor invasion, VBOS is classified into 3 categories: threatened is defined as vessel encased by a tumor, impending describes bleeds that can be managed by nonoperative conservative measures, and acute vascular blowout includes cases with massive lifethreatening hemorrhage. 2,3 Neoplasms affecting the iliac circulation with acute VBOS have rarely been reported in the literature. 6,7 Emergent surgery has been described to treat acute VBOS with or without extra-anatomic reconstruction of the affected vascular territory 6 ; however, surgical interference may delay induction of adjunctive or palliative therapy until surgical wound healing is accomplished.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endovascular Management of External Iliac Blowout Syndrome Secondary to Recurrent Sigmoid Cancer

Abdelsalam

Elmokadem

2019

Vasc Endovascular Surg

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Blowout syndrome caused by vascular invasion is a dreadful complication of late stage malignancies that carry high morbidity and poor overall prognosis in a compromised population. Endovascular management can offer minimally invasive and life-saving alternative for such acute conditions. We describe the case of a 62-year-old man with massive fresh bleeding per rectum and shock resulting from rupture of the left external iliac artery secondary to nearby infiltrative recurrent sigmoid cancer. This complication is rare, presents dramatically, and is frequently fatal. The patient was successfully treated with a stent graft deployment in order to achieve hemostasis and reinstituting the arterial integrity.

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Multimodal Endovascular Palliation for Femoral Arterial Blowout in the Setting of Metastatic Vulvar Carcinoma

Nassiri

Kogan

Gibbon

et al. 2015

Annals of Vascular Surgery

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Endovascular Palliation of Multivessel Blowout Syndrome in the Setting of a Nonresectable Neck Sarcoma

Cited by 8 publications

References 10 publications

Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout

Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout

Endovascular Management of External Iliac Blowout Syndrome Secondary to Recurrent Sigmoid Cancer

Multimodal Endovascular Palliation for Femoral Arterial Blowout in the Setting of Metastatic Vulvar Carcinoma

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