Multidisciplinary damage control management of life-threatening carotid blowout syndrome

A 63-year-old patient arrived at our trauma center with profuse arterial bleeding from zone 2 on the right side of his neck. He was alert with a heart rate of 130 beats per minute and a blood pressure of 150/100 mm Hg. There was initial confusion regarding what had precipitated the bleeding. The patient clearly had undergone prior head and neck operation and radiation, marked by a chronic ulcerated wound with extensive fibrosis around the bleeding site and a laryngectomy stoma. The latter was quickly intubated and the patient resuscitated with blood products. Manual compression was applied to the bleeding site. We later learned that a scab had recently formed at the site and the patient had displaced it while shaving, eliciting the hemorrhage from a partially exposed right common carotid artery. Unbeknown to our team, the patient’s medical history was significant for squamous cell carcinoma of the larynx treated more than 15 years ago. Given the complexity of his cervical wound, the decision was made to proceed to the angiography suite, where an endovascular stent was successfully deployed to exclude the arterial defect and hemostasis. This allowed the wound to be fully visualized, revealing that the stent was exposed within the artery (figure 1). Figure 1 Exposed stent in the right common carotid artery (arrow) within a chronic ulcerated fibrotic wound on the right side of the patient’s neck. An endotracheal tube inserted through the …