Predisposing factors, management, and prognostic evaluation of acute carotid blowout syndrome

Hsueh Ju Lu, Kuo Wei Chen, Ming Huang Chen, Pen Yuan Chu, Shyh Kuan Tai, Ling Wei Wang, Peter Mu Hsin Chang*, Muh Hwa Yang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Background: Massive hemorrhages occur in 6%-10% of patients with advanced cancer. Acute carotid blowout syndrome is the most severe massive hemorrhagic complication in head and neck cancer patients. Methods: This was a single institute, retrospective, case control study. A total of 45 patients were enrolled in this study. The predisposing factors, management, and prognosis of acute carotid blowout syndrome were evaluated. Results: Among the baseline characteristics, the site of the primary tumor (P =.003), origin of bleeding (P =.048), method of intervention (P =.005), and time to intervention (P =.006) were significantly different factors between survivor and nonsurvivor patients. After 24 hours of onset, a Glasgow Coma Scale score (P =.000), the use of inotropic agents (P =.007), and neutrophil-to-lymphocyte ratio (P =.019) were significantly predicting factors for outcome. Multivariate logistic regression analyses revealed bleeding from common carotid artery was an independent factor for long-term survival (odds ratio, 25.951; 95% confidence interval [CI], 1.373-490.441; P <.030). The median overall survival of survivors and nonsurvivors were 12.1 (range, 3.7-118.7; 95% CI, 4.33-54.87) and 11.9 (range, 0.7-53.5; 95% CI, 5.78-25.69) months, respectively (P =.092). Conclusions: Early and aggressive intervention is important for the successful management of acute carotid blowout syndrome. The Glasgow Coma Scale score, the use of inotropic agents, and neutrophil-to-lymphocyte ratio 24 hours after the onset were predictive factors for patients' outcomes. Bleeding from common carotid artery is an independent prognostic factor in multivariate analysis. Long-term survival can be achieved after successful management.

Original languageEnglish
Pages (from-to)1226-1235
Number of pages10
JournalJournal of Vascular Surgery
Issue number5
StatePublished - Nov 2013


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