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Endovascular Management of Post-Irradiated Carotid Blowout Syndrome.

Chang FC, Luo CB, Lirng JF, Lin CJ, Lee HJ, Wu CC, Hung SC, Guo WY - PLoS ONE (2015)

Bottom Line: The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435).The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155).The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.

ABSTRACT

Purpose: To retrospectively evaluate the clinical and technical factors related to the outcomes of endovascular management in patients with head-and-neck cancers associated with post-irradiated carotid blowout syndrome (PCBS).

Materials and methods: Between 2000 and 2013, 96 patients with PCBS underwent endovascular management. The 40 patients with the pathological lesions located in the external carotid artery were classified as group 1 and were treated with embolization. The other 56 patients with the pathological lesions located in the trunk of the carotid artery were divided into 2 groups as follows: group 2A comprised the 38 patients treated with embolization, and group 2B comprised the 18 patients treated with stent-graft placement. Fisher's exact test was used to examine endovascular methods, clinical severities, and postprocedural clinical diseases as predictors of outcomes.

Results: Technical success and immediate hemostasis were achieved in all patients. The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435). The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155). The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).

Conclusion: The outcomes of endovascular management of PCBS can be improved by taking embolization as a prior way of treatment, performing endovascular intervention in slight clinical severity and aggressive management of the post-procedural clinical disease.

No MeSH data available.


Related in: MedlinePlus

Algorithm of endovascular management of post-irradiated carotid blowout syndrome (PCBS).CT/CTA*: reference 7, 21. The soft tissue lesions include necrotic tumor, soft tissue wound and pharyngocutaneous fistula; the vascular lesions include pseudoaneurysm or extravasation. Dash line: indicates follow-up after the initial management.
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pone.0139821.g003: Algorithm of endovascular management of post-irradiated carotid blowout syndrome (PCBS).CT/CTA*: reference 7, 21. The soft tissue lesions include necrotic tumor, soft tissue wound and pharyngocutaneous fistula; the vascular lesions include pseudoaneurysm or extravasation. Dash line: indicates follow-up after the initial management.

Mentions: We found that patients with resolution/regression of clinical disease had significantly longer hemostatic periods and better survival outcomes than those of persistence/progression of clinical disease (Table 2). In addition to prolonging life expectancy by cancer therapy, aggressive management of the tumor and/or soft tissue lesion of head and neck region can provide the following benefits to improve the survival outcomes of PCBS: 1. Approximately 80% blood supply of the wall of carotid artery comes from the adventia and the surrounding soft tissue [9]. Management of the adjacent soft tissue lesion can prevent rebleeding by restoring the blood supply to the diseased carotid arteries and controlling the disease progression to involve the other vascular territory. 2. The contaminated soft tissue lesions can progress to uncontrollable systemic infection or sepsis, which impair the patient’s survival. As the management of post-procedural clinical disease is related to the hemostatic and survival outcomes, we propose an algorithm to highlight the decision of patient selection and postprocedural follow-up (Fig 3). However, our findings in the patients’ survival are still minimal because of the limited numbers of the patients and the difficulty of management of the advanced clinical disease processes.


Endovascular Management of Post-Irradiated Carotid Blowout Syndrome.

Chang FC, Luo CB, Lirng JF, Lin CJ, Lee HJ, Wu CC, Hung SC, Guo WY - PLoS ONE (2015)

Algorithm of endovascular management of post-irradiated carotid blowout syndrome (PCBS).CT/CTA*: reference 7, 21. The soft tissue lesions include necrotic tumor, soft tissue wound and pharyngocutaneous fistula; the vascular lesions include pseudoaneurysm or extravasation. Dash line: indicates follow-up after the initial management.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4595276&req=5

pone.0139821.g003: Algorithm of endovascular management of post-irradiated carotid blowout syndrome (PCBS).CT/CTA*: reference 7, 21. The soft tissue lesions include necrotic tumor, soft tissue wound and pharyngocutaneous fistula; the vascular lesions include pseudoaneurysm or extravasation. Dash line: indicates follow-up after the initial management.
Mentions: We found that patients with resolution/regression of clinical disease had significantly longer hemostatic periods and better survival outcomes than those of persistence/progression of clinical disease (Table 2). In addition to prolonging life expectancy by cancer therapy, aggressive management of the tumor and/or soft tissue lesion of head and neck region can provide the following benefits to improve the survival outcomes of PCBS: 1. Approximately 80% blood supply of the wall of carotid artery comes from the adventia and the surrounding soft tissue [9]. Management of the adjacent soft tissue lesion can prevent rebleeding by restoring the blood supply to the diseased carotid arteries and controlling the disease progression to involve the other vascular territory. 2. The contaminated soft tissue lesions can progress to uncontrollable systemic infection or sepsis, which impair the patient’s survival. As the management of post-procedural clinical disease is related to the hemostatic and survival outcomes, we propose an algorithm to highlight the decision of patient selection and postprocedural follow-up (Fig 3). However, our findings in the patients’ survival are still minimal because of the limited numbers of the patients and the difficulty of management of the advanced clinical disease processes.

Bottom Line: The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435).The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155).The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.

ABSTRACT

Purpose: To retrospectively evaluate the clinical and technical factors related to the outcomes of endovascular management in patients with head-and-neck cancers associated with post-irradiated carotid blowout syndrome (PCBS).

Materials and methods: Between 2000 and 2013, 96 patients with PCBS underwent endovascular management. The 40 patients with the pathological lesions located in the external carotid artery were classified as group 1 and were treated with embolization. The other 56 patients with the pathological lesions located in the trunk of the carotid artery were divided into 2 groups as follows: group 2A comprised the 38 patients treated with embolization, and group 2B comprised the 18 patients treated with stent-graft placement. Fisher's exact test was used to examine endovascular methods, clinical severities, and postprocedural clinical diseases as predictors of outcomes.

Results: Technical success and immediate hemostasis were achieved in all patients. The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435). The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155). The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).

Conclusion: The outcomes of endovascular management of PCBS can be improved by taking embolization as a prior way of treatment, performing endovascular intervention in slight clinical severity and aggressive management of the post-procedural clinical disease.

No MeSH data available.


Related in: MedlinePlus