case of carotid artery secondary hemorrhage successfully managed by extra anatomic axillary-internal carotid bypass

ABSTRACT

Carotid artery rupture post oncologic Head and Neck surgery is relatively rare but potentially lethal complication. To the best of the author's knowledge, the management options are restricted to ligation and resection of the pathologic segment of the artery accepting with helplessness a potential of stroke and sometimes mortality secondary to interruption of the blood supply of the brain. A patient with recurrent tongue cancer post resection and radiofrequency ablation. Salivary leak and infection in the neck resulted in a "Blow out" of the bifurcation of the carotid artery. Bleeding was controlled by minimal digital pressure, awakening test during cross clamping of the internal carotid artery lead to neurologic deficit. An extra-anatomic bypass was constructed with the inflow from the axillary artery and the outflow at the internal carotid artery at the skull base above and separate from the infected area and the tunnel in the posterior triangle of neck away from infection. The patient suffered no neurologic deficit. The vascular exposure wounds healed uneventfully .The patient was sent to chemotherapy. Occlusion of the graft occurred silently and hence left well alone. We hope that this bypass, or perhaps any other better option, proves to offer a management option for this frustrating morbidity that carries the risk of adding a neurologic deficit to the misery of the advanced head and neck malignancy