An algorithmic addition for Carotid Blowout Syndrome type 1

OBJECTIVE: This study focuses on early recognition of carotid blowout syndrome type 1 (threatened artery) and the results of integrity restoration of the surrounding tissue by a pectoralis major myofascial flap. METHODS: This retrospective study included all patients in the period 2010-2020 with carotid blowout syndrome type 1 of the common or internal carotid artery, treated by pectoralis major myofascial flap. RESULTS: Fifteen patients with carotid blowout syndrome type 1 were included, all but one after previous radiotherapy with a total dose up to 136 Gray (range 46-136). Median time from diagnosis till treatment was 1 day. None of the patients progressed to actual bleeding (type 2 or 3). CONCLUSION: Carotid blowout syndrome type 1 should be early recognised and treated by insertion of a pectoralis major myofascial flap that protects the common or internal carotid artery and might prevent progression to a potentially fatal bleed. In our opinion, this policy should be part of the algorithmic approach of this complication.