Transarterial embolization of acute external carotid blowout syndrome with profuse oronasal bleeding by N-butyl-cyanoacrylate

Objectives Assess duration, efficacy, and safety of emergent transarterial embolization of acute external carotid blowout syndrome (ECBS) with N-butyl-cyanoacrylate. Methods Medical records were reviewed for 16 patients (15 men, 1 woman; age range, 28-85 years) who had 17 acute ECBS events that presented with profuse transoronasal bleeding. Predisposing factors were carcinoma associated with surgery and/or radiotherapy (n = 14) or trauma (n = 3). Affected arteries were the internal maxillary artery (n = 5), superior thyroid artery (n = 4), lingual artery (n = 4), facial artery (n = 2), or ascending pharyngeal artery (n = 2). Results Endovascular treatment successfully obliterated all acute ECBSs with cessation of profuse hemorrhage. Mean duration of procedure was 54 minutes. Three patients had recurrent carotid blowout syndrome events, with 1 resulting death. Clinical follow-up range was 2 to 23 months. Conclusions Transarterial N-butyl-cyanoacrylate embolization can successfully manage acute ECBS with profuse hemorrhage. The technique is both efficient and safe, and the procedure can be rapidly completed.