Management and prevention of acute bleedings in the head and neck area with interventional radiology

Abstract

BackgroundThe Interventional Neuroradiology is becoming more important in the interdisciplinary treatment of acute haemorrhages due to vascular erosion and vascular tumors in the head and neck area. The authors report on acute extracranial haemorrhage in emergency situations but also on preventive embolization of good vascularized tumors preoperatively and their outcome.MethodsRetrospective analysis of 52 patients, who underwent an interdisciplinary approach of the ORL Department and the Interventional Neuroradiology over 5 ½ years at the Department of Otorhinolaryngology, Klinikum Rechts der Isar, Technical University of Munich, Germany. Their outcome was analysed in terms of success of the embolization, blood loss, survival rate and treatment failures.Results39/52 patients were treated for acute haemorrhage. Twenty-five of them attributable to vascular erosion in case of malignant tumors. Affected vessels were the common carotid artery as well as its internal and external parts with branches like the ascending pharyngeal, the facial and the superior thyroid artery.Altogether 27/52 patients were treated for malignant tumors, 25/52 were attributable to acute haemorrhage due to epistaxis, after tonsillectomy, benign tumors and bleeding attributable to inflammations. Treatment of all patients consisted either of an unsuccessful approach via exposure, package of the bleeding, electrocoagulation or surgical ligature followed by embolization or the primary treatment via interventional embolization/stenting.ConclusionsThe common monitoring of patients at the ORL and interventional neuroradiology is an important alternative especially in the treatment of severe acute haemorrhage, following vascular erosion in malignant tumors or benign diseases. But also the preoperative embolization of good vascularized tumors must be taken into account to prevent severe blood loss or acute intraoperative bleeding.

The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC)

“…Immune-related adverse events can affect any organ system including manifestations as colitis, pneumonitis, endocrinopathies, or hepatitis, for example [14, 43, 92, 93, 95]. Additional management considerations in patients with HNSCC include complications such as potential bleeding, including carotid artery rupture, airway compromise due to tumor bulk, and facial edema [99, 100]. The subcommittee discussed irAE management strategies in patients with R/M HNSCC.…”

Stent grafts in patients with carotid blowout syndrome: Outcome and antiplatelet therapy in preventive versus emergency cases

“…The 2 cases in which only acetylsalicylic acid was administered both preprocedurally and postprocedurally represented the first 2 stent graft implantations in our institution in patients with carotid blowout syndrome. At that time, most acute bleedings were still treated by embolization, and the experience with stent grafts was limited.…”

Major haemorrhage requiring transarterial embolisation following open biopsy of an unusual neck mass

“…Major haemorrhage from open biopsy in the head and neck is associated with specific tumour types including juvenile angiofibromas, paragangliomas and some thyroid malignancies. 3 However, the incidence of clinically significant haemorrhage from open biopsy in any other type of lesion is poorly described in the literature.…”

“…However, these cases were specific head and neck tumour types including paragangliomas, juvenile nasopharyngeal angiofibroma and thyroid lesions. 3 There is currently no described role for pre or intraoperative embolisation in suspected Ewing's sarcoma.…”

“…Interventional radiology plays a key role in managing refractory haemorrhage and is widely employed for vascular erosions from malignant tumours, refractory epistaxis and bleeding following tonsillectomy. 3 Despite haemorrhage being a recognised risk of open biopsy, there is a paucity of published evidence on this topic. We describe an unusual case of major intraoperative haemorrhage from an open biopsy and its management.…”