Recurrent Carotid Blowout Syndrome Managed by Infratemporal Internal Carotid Ligation: A Case Report

Area of Science:

• Vascular Surgery
• Head and Neck Oncology
• Interventional Radiology

Background:

• Carotid blowout syndrome (CBS) is a rare, life-threatening complication following head and neck cancer treatment.
• Endovascular intervention is the primary treatment, but surgical ligation is crucial when endovascular methods fail.

Purpose of the Study:

• To present a case of recurrent carotid blowout syndrome (CBS) distal to a previously ligated common carotid artery.
• To highlight the efficacy of surgical ligation via a preauricular infratemporal approach in managing complex CBS.

Main Methods:

• A 59-year-old male with oropharyngeal carcinoma experienced recurrent CBS after initial treatment.
• Initial management involved surgical ligation of the left common carotid artery (CCA) due to infeasible endovascular options.
• Recurrent CBS was treated with surgical ligation of the internal carotid artery (ICA) via a preauricular infratemporal approach with intraoperative navigation.

Main Results:

• The initial CCA ligation was a life-saving measure.
• The subsequent infratemporal ICA ligation successfully controlled a pseudoaneurysm and prevented rebleeding for 3 years.
• This approach proved feasible and effective for CBS distal to a previously occluded carotid artery.

Conclusions:

• Surgical ligation of the internal carotid artery (ICA) through an infratemporal approach is a viable and critical treatment for recurrent carotid blowout syndrome (CBS) when endovascular options are exhausted.
• This case underscores the importance of surgical expertise in managing complex vascular emergencies in head and neck cancer patients.