Carotid Blowout Syndrome in Head and Neck Cancer Patients: Management of Patients At Risk for CBS

• Published in: The Laryngoscope 2023-03, Vol.133 (3), p.576-587
• Main Authors: Slijepcevic, Allison A., Roh, Joseph, Pipkorn, Patrik, Lipsey, Kim, Bradley, Joseph P.
• Format: Article
• Language: English
• Subjects: Carotid Arteries; Carotid Artery Diseases - etiology; carotid blowout; carotid blowout syndrome; CBS; Head & neck cancer; head and neck cancer; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - therapy; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Laryngoscopy; Neoplasm Recurrence, Local; Radiation therapy; Retrospective Studies; Risk factors; Stents - adverse effects; Systematic review
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.30157

Objectives Carotid blowout syndrome (CBS) is an acute, rare life‐threatening hemorrhage that occurs in patients with a history of head and neck cancer and radiation therapy. The primary objective of this review was to identify risk factors and assess treatment and survival outcomes following CBS. Methods A systematic review of published literature was performed. Information including risk factors, treatment, and outcomes of CBS were collected. Results A total of 49 articles and 2220 patients were included in the systematic review. Risk factors for developing CBS included a history of radiation therapy, wound complications, and advanced tumor stage. The initial management of CBS included establishing a stable airway, gaining hemostasis, and repletion of blood loss. Endovascular and surgical procedures treat CBS with infrequent rates of rebleeding and periprocedural complications. Short‐term survival following treatment of CBS shows high survival rates when considering CBS‐related complications and underlying disease, however, long‐term survival related to the underlying disease demonstrated high mortality. Conclusions Identifying patients at risk for CBS enables practitioners to counsel patients on life‐saving interventions and expected outcomes following treatment of CBS. Treatment of CBS is associated with high short‐term survival, although long‐term survival related to underlying disease is low. Level of Evidence N/A Laryngoscope, 133:576–587, 2023 This article is a systematic review of the risk factors and management of carotid blowout syndrome in patients with head and neck cancer. The article provides an algorithm to identify and manage at risk of the carotid blowout.