Abstract No. 568 Endovascular management of vascular involvement by head and neck malignancies

Abstract

Endovascular techniques as a preferable alternative for palliative and definitive treatment of head and neck vascular involvement by malignancies. Retrospective electronic medical records review was conducted of all patients with vascular involvement in head and neck malignancies at our institution from 2013 to 2019. Relevant imaging and techniques were reviewed. Imaging features of head and neck vascular involvement were evaluated and appropriate endovascular technique for optimum treatment was chosen. F/U was conducted in the following 6-18 months. Carotid involvement was classified as threatened (I), impending (II) or hemorrhage (III). 9 patients (2 women and 7 men) with an average age of 53 years (range, 33-73 years) were reviewed. 7 patients had positive history for squamous cell carcinoma of the neck,1 had extensive parathyroid malignancy, 1 had recurrent tongue base cancer and 1 had tonsillar Ca. 4 had active hemorrhage while 2 had threatened blowout and 2 had impending blowout. 7 patients had covered stents. 1 patient had embolization with microsphere and coil while 1 patient had embolization with coils only. No carotid was sacrificed. No patients died as a result of their initial hemorrhage. Two patients experienced recurrent bleed inspite of using covered stents. At an average follow-up of 12 (range, 6-18 months), 4 patients were alive, three had died as a result of their malignancy, and two had died of other causes. No patient died of uncontrolled hemorrhage. Endovascular treatment options for patients with terminal malignant disease with head and neck vascular involvement include use of covered stent, coils, MVP and embolizing agents. In threatened or impending blow out endovascular therapy can offer palliative treatment to prevent bleed. It may minimize the risks of repeat surgery and improve over all morbidity and mortality. The risks of mortality and recurrent hemorrhage after vascular interventions are low in head and neck malignancies.Tabled 1Age/ sexMalignancySymptomsImagingTypeIntervention53/MTonguebase cancer with metastases to the cervical LNBleedingFocal contrast extravastion left CCAHemorrhageCarotid-6 mm x 5 cm and 7 mm x 5 cm viabhan stents65/MParathyroid malignancyHemorrhageExtravasation point as well as the rest of the irregular area involved by the tumorHemorrhage7mm x 10 cm Viabahn stent was deployed in the right common carotid60/MRecurrent right tonsillar squamous cell carcinomaAsymptomaticSoft tissue mass in the right level 2 region with encasement of carotidsImpendingViabahn 5mm x 5cm stent carotid and embolization of right external carotid artery with detachable coils and microvascular plugs.58/MInvasive SCC tongue involving mandibleHemorrhageMicrospheres and a vascular coilHemorrhagemicrospheres and a vascular coil71/FLaryngeal cancerpharyngocu taneous fistula6-8 mm pseudoaneurysm arising from the mid left common carotid arteryHemorrhageTwo 6 mm x 5 cm Viabahn stents in carotid artery73/FSCC of the palate s/p total laryngopharyngectomyExposed carotidSCC of the palate s/p total laryngopharyngectomyThreatened5 mm x 10 cm Viabahn stent -RT CCA61/mMetastatic oral squamous cell carcinomaHemoptysisEnhancing and necrotic mass lesion centered in the right masticator spaceImpendingECA POD4 retractable coil61/mExtensive buccal SCC with resection and recurrenceExposed carotidNecrotic mass engulfs the distal right common carotid arteryThreatened5 mm x 5 cm Viabahn stent - mid/proximal internal carotid artery/7 mm x 5 cm Viabahn stent -common carotid bifurcation.33/MSupraglottic squamous cell carcinomaAsymptomaticNew soft tissue surrounding the carotidThreatened8 mm x 7.5 cm Viabahn VBX stent proximal right common carotid artery53/MTonguebase cancer with metastases to the cervical LNBleedingFocal contrast extravastion left CCAHemorrhageCarotid-6 mm x 5 cm and 7 mm x 5 cm viabhan stents65/MParathyroid malignancyHemorrhageextravasation point as well as the rest of theHemorrhage7mm x 10 cm Viabahn stent was deployed in the right common carotid Open table in a new tab