Outcomes for Carotid Blowout Interventions in Patients With Head and Neck Cancer

Abstract

Methods: We performed an extensive literature search using PubMed and found 274 articles referencing tumor invasion of the carotid, with 31 articles describing carotid reconstruction in the setting of tumor invasion. There were no reports using Artegraft for carotid reconstruction. Results: A 65-year-old man presented with a large left neck mass. Computed tomography angiography (CTA) of the neck demonstrated a complex 9.1-cm 5.9-cm 7.5-cm mass encasing and invading the cervical internal carotid artery (Fig 1). Fine-needle aspiration revealed squamous cell carcinoma. Furthermore, he had an incomplete circle of Willis on CTA and no viable vein conduit on duplex mapping. The patient underwent en bloc resection of the left neck tumor, including a portion of the cervical internal carotid artery, followed by reconstruction with the Artegraft (Fig 2). Brachytherapy catheters were left in place, followed by pectoralis major rotational flap for coverage. At the conclusion of the procedure, there were multiphasic Doppler signals throughout the graft. The procedure was well tolerated, and the patient had an uneventful course with no neurologic sequelae. Conclusions: To our knowledge, this is the first case reported of tumor invasion of the internal carotid reconstructed using Artegraft bovine heterograft as conduit. This novel approach provides an alternative to synthetic conduit when there is an increased concern for infection and need for a durable repair in a patient without suitable autologous conduit.