[Clinical study of carotid artery rupture in head and neck cancer].

OBJECTIVE

To assess the efficacy and safety of carotid ligation in the treatment of the carotid artery rupture(CAR).

METHODS

A series of 30 patients who had CAR treated with carotid ligation were reviewed. There were 24 males and 6 females ranging in age from 32 to 76 years, with a mean of 53.9 years. The original sites of tumours were hypopharynx (n = 11), larynx (n = 5), thyroid (n = 6) and others (n = 8). Of the 30 patients, 24 patients had received radiotherapy from 40 - 126 Gy and 10 patients underwent one or more surgical treatments. CAR in all cases occurred after surgical operation. CAR occurred in 5 - 21 days after operation.

RESULTS

By pressing the carotid and keeping breathe of the patients immediately after CAR, 25 patients were conscious, 2 patients in coma, and 3 patients died before carotid ligation. Seven cases were applied with carotid ligation, 3 cases with the combined ligation of carotid and brachiocephalic arteries, and 17 cases with carotid ligation plus the repair by pectoralis major myocutaneous flap. The causes of CAR concluded fistula, wound dehiscence, wound infection and transferred flap necrosis. The mende hemorrhage occurred in 14 patients. Of 25 cases with the treatments of carotid ligation, 22 patients survived with no complication, 1 with brief muscle weakness and 2 with unconscious. Clinical follow-up period lasted more than 5 years at least in 6 patients.

CONCLUSIONS

CAR is the most dangerous complication in advanced carcinoma of the head and neck. The prompt hemostasis and carotid ligation are effective methods to rescue patients of CAR. It is important to keep patients conscious before carotid ligation surgery, with low rates of death and hemiplegia postoperatively.