Classification of haemorrhage following tonsillectomy

2001 ◽  
Vol 115 (6) ◽  
pp. 457-461 ◽  
Author(s):  
Windfuhr ◽  
Seehafer
Keyword(s):  
Blood Transfusion ◽  
Incidence Rates ◽  
External Carotid Artery ◽  
External Carotid ◽  
Lethal Outcome ◽  
Grade 5 ◽  
Life Threatening ◽  
Secondary Haemorrhage ◽  
Grade 3

To date there exists no sensible way of classifying the intensity of haemorrhage following tonsillectomy, though this is a prerequisite when comparing the results presented in literature. We evaluated the incidence of post-operative haemorrhage according to our classification in 602 patients who underwent tonsillectomy at our department in 1999. In 21 patients a grade 1 (spontaneous cessation) bleeding occurred. One patient had a grade 2 (infiltration anaesthesia), 14 patients had a grade 3 bleeding (treatment under general anaesthesia) with one patient receiving a blood transfusion. Two patients had a grade 4 bleeding (ligature of the external carotid artery). There was no patient with grade 5 bleeding (lethal outcome). Grades 1 and 3 had the same incidence rates. Primary haemorrhage (<24 hours) can be expected in the majority of patients undergoing tonsillectomy. Secondary haemorrhage is rare and can be life-threatening.

Fulminant post-tonsillectomy haemorrhage caused by aberrant course of the external carotid artery

2005 ◽  
Vol 119 (8) ◽  
pp. 655-657 ◽  
Author(s):  
Rutger Hofman ◽  
Clark J Zeebregts ◽  
Frederik G Dikkers
Keyword(s):  
Carotid Artery ◽  
Surgical Intervention ◽  
External Carotid Artery ◽  
External Carotid ◽  
Throat Pain ◽  
Life Threatening ◽  
Secondary Haemorrhage

Haemorrhage, throat pain and otalgia are common complications following tonsillectomy. Haemorrhage is rarely life-threatening but in this paper we describe a fulminant secondary haemorrhage due to an aberrant external carotid artery in an eight-year-old boy. Acute surgical intervention with ligation of the external carotid artery was needed to control the bleeding.

scholarly journals Intensity of hemorrhage following tonsillectomy

2012 ◽  
Vol 69 (6) ◽  
pp. 500-503 ◽  
Author(s):  
Dusanka Milosevic
Keyword(s):  
Blood Transfusion ◽  
Bleeding Event ◽  
Standard Technique ◽  
Grade Classification ◽  
Number Of Patients ◽  
Life Threatening ◽  
Grade 3 ◽  
Cold Dissection ◽  
Endotracheal Anesthesia

Background/Aim. Although post-tonsillectomy hemorrhage is one of the most frequent and potentially life-threatening complications, there is no generally accepted classification of post-operative bleeding intensity. The aim of this study was to evaluate the intensity of post-tonsillectomy hemorrhage according to the five-grade classification. Methods. A total of 408 consecutive patients, aged 2 to 54 years, undergoing elective tonsillectomy, with (n=261) or without (n=147) adenoidectomy, were included in this prospective study. Tonsillectomy was performed under general anesthesia using standard technique of cold dissection with a snare. Any bleeding event was recorded. The severity of post-operative hemorrhage was classified in five grades. Results. In 11 (2.70%) of the patients grade 1 hemorrhage following tonsillectomy occurred, 4 (0.98%) had grade 2 and 2 (0.49%) of the patients had grade 3 post-operative bleeding. Grades 4 and 5 were not recorded, and no patient received a blood transfusion. Conclusion. Post-tonsillectomy hemorrhage can be expected in a small number of patients undergoing tonsillectomy. Hemorrhage is mostly primary and rarely requires treatment under endotracheal anesthesia and blood transfusion.

Giant life-threatening external carotid artery pseudoaneurysm caused by a mandibular condylar fracture

2015 ◽  
Vol 119 (3) ◽  
pp. e95-e100 ◽  
Author(s):  
André Luis Ribeiro Ribeiro ◽  
Walessa Brasil da Silva ◽  
Sérgio de Melo Alves-Junior ◽  
João de Jesus Viana Pinheiro
Keyword(s):  
Carotid Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Condylar Fracture ◽  
Artery Pseudoaneurysm ◽  
Life Threatening

Safety of resuming anti-PD-1 (aPD1) in patients (pts) with immune-related adverse events (irAEs) during combined anti-CTLA-4 (aCTLA4) and aPD1 in metastatic melanoma (MM).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9544-9544 ◽  
Author(s):  
Megan Pollack ◽  
Allison Shayna Betof ◽  
Katherine Rappazzo ◽  
Ian Valentine ◽  
Zeynep Eroglu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adverse Events ◽  
Progression Free Survival ◽  
Neurologic Complications ◽  
Early Discontinuation ◽  
Free Survival ◽  
Safety And Efficacy ◽  
Grade 5 ◽  
Life Threatening ◽  
Grade 3

9544 Background: Combination aPD1 and aCTLA4 has demonstrated greater response rates (RR) than aPD1 alone in MM. However, aPD1 + aCTLA4 also leads to more frequent and severe irAEs compared to aPD1. The safety of resuming aPD1 following these irAEs is not known. We characterized the safety and efficacy of resuming aPD1 following severe irAEs during aPD1 + aCTLA4 in pts with MM. Methods: We retrospectively reviewed mm pts from 3 academic centers who had a severe irAE with aPD1 + aCTLA4 (defined as CTCAE v4.03 G3-4 or leading to early discontinuation of aPD1 + aCTLA4) and who resumed aPD1 thereafter. We assessed for frequency, timing, and spectrum of irAEs as well as RR, progression free survival (PFS) and overall survival (OS). Results: We identified 64 pts who received aPD1 + aCTLA4 for a median of 2 doses (range, 1-4). The most frequent irAEs that led to aPD1 + aCTLA4 discontinuation were: colitis (36%), hepatitis (23%), hypophysitis (8%), pneumonitis (5%), nephritis (3%), neurologic complications (3%), and pancreatitis (3%); eight pts (13%) had > 1 concurrent severe irAEs. aPD1 was resumed at a median of 55 days after last dose of aCTLA4 + aPD1 (range, 17-289); 23% experienced recurrence of the same irAE with aPD1 monotherapy, 16% experienced a distinct irAE, and 60% did not experience any severe irAE after resuming aPD1. Hepatitis recurred in 6 of 18 pts, pancreatitis in 2 of 2, dermatitis in 1 of 4, nephritis in 1 of 2, pneumonitis in 1 of 3, hypophysitis in 1 of 5, and colitis in 1 of 27; the grade of these recurrent irAEs was: 46% grade 1-2, 33% grade 3, 13% grade 4, and 7% grade 5 (n = 1). One death from irAEs occurred related to Toxic Epidermal Necrolysis (TEN). No difference was observed in time prior to resuming aPD1 in those that had recurrent irAEs vs. those without (median 56 days each). The RR in this cohort was 73% (30% CR; 44% PR); median PFS (range, 2.2-not reached (NR)) and OS (range, 2.4-NR) were not reached. Conclusions: In our experience, pts who resume aPD1 following irAEs with aPD1 + aCTLA4 exhibit variable toxicity profiles with most experiencing no irAEs, but a minority experiencing severe or life-threatening irAEs. We observed excellent efficacy in this cohort.

scholarly journals Spontaneous Aneurysm of External Carotid Artery: Management and Complications

2018 ◽  
Vol 4 (02) ◽  
pp. 081-084
Author(s):  
Pankaj Banode ◽  
Abhinav A. Mohan ◽  
Shishir Ravekar ◽  
Priyanka Banode ◽  
Pushan Sharma
Keyword(s):  
Carotid Artery ◽  
Artery Aneurysm ◽  
External Carotid Artery ◽  
Laryngeal Edema ◽  
External Carotid ◽  
Extracranial Carotid Artery ◽  
Mortality And Morbidity ◽  
Carotid Artery Aneurysm ◽  
Life Threatening ◽  
Large Aneurysm

AbstractExtracranial carotid artery aneurysm is a rare vascular disease in the neck with variable presentation. Aneurysms are associated with significant mortality and morbidity and are associated with fatal complication secondary to spontaneous rupture or tracheal compression or laryngeal edema and distal embolization. A 43-year-old male patient presented with large aneurysm arising from proximal common carotid artery (CCA) causing tracheal obstruction leading to life-threatening respiratory symptoms. The endovascular interventional management is an emerging alternative for surgical option and providing promising results with almost similar safety and efficacy. Endovascular management of an extracranial carotid artery aneurysm using stent graft is minimally invasive and effective.

scholarly journals Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma

2020 ◽  
Vol 54 (3) ◽  
pp. 253-262
Author(s):  
Crt Langel ◽  
Dimitrij Lovric ◽  
Ursa Zabret ◽  
Tomislav Mirkovic ◽  
Primoz Gradisek ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Injury Severity ◽  
Transarterial Embolization ◽  
Treatment Options ◽  
Case Series ◽  
External Carotid Artery ◽  
Maxillofacial Trauma ◽  
External Carotid ◽  
Severe Bleeding ◽  
Life Threatening

AbstractBackgroundSevere bleeding after blunt maxillofacial trauma is a rare but life-threatening event. Non-responders to conventional treatment options with surgically inaccessible bleeding points can be treated by transarterial embolization (TAE) of the external carotid artery (ECA) or its branches. Case series on such embolizations are small; considering the relatively high incidence of maxillofacial trauma, the ECA TAE procedure has been hypothesized either underused or underreported. In addition, the literature on the ECA TAE using novel non-adhesive liquid embolization agents is remarkably scarce.Patients and methodsPubMed review was performed to identify the ECA TAE literature in the context of blunt maxillofacial trauma. If available, the location of the ECA injury, the location of embolization, the chosen embolization agent, and efficacy and safety of the TAE were noted for each case. Survival prognostic factors were also reviewed. Additionally, we present an illustrative TAE case using a precipitating hydrophobic injectable liquid (PHIL) to safely and effectively control a massive bleeding originating bilaterally in the ECA territories.Results and conclusionsBased on a review of 205 cases, the efficacy of TAE was 79.4–100%, while the rate of major complications was about 2–4%. Successful TAE haemostasis, Glasgow Coma Scale score ≥ 8 at presentation, injury severity score ≤ 32, shock index ≤ 1.1 before TAE and ≤ 0.8 after TAE were significantly correlated with higher survival rate. PHIL allowed for fast yet punctilious application, thus saving invaluable time in life-threatening situations while simultaneously diminishing the possibility of inadvertent injection into the ECA-internal carotid artery (ICA) anastomoses.

scholarly journals Intervening in the Acute Phase of Postradiation Carotid Blowout Syndrome

2019 ◽  
Vol 23 (02) ◽  
pp. 172-177 ◽  
Author(s):  
Marrigje A. de Jong ◽  
Carlos Candanedo ◽  
Menachem Gross ◽  
José E. Cohen
Keyword(s):  
Carotid Artery ◽  
Endovascular Procedures ◽  
Palliative Therapy ◽  
Surgical Excision ◽  
External Carotid Artery ◽  
External Carotid ◽  
Covered Stents ◽  
Carotid Blowout Syndrome ◽  
Life Years ◽  
Life Threatening

Introduction Acute carotid blowout syndrome (aCBS) is a severe complication of head and neck cancer (HNC). It can be defined as a rupture of the extracranial carotid arteries, or one of their branches, that causes life-threatening hemorrhage, and which nowadays can be treated with urgent endovascular intervention. Objective We retrospectively evaluate the endovascular management of aCBS and its outcome in years of survival. Methods Retrospectively, we describe our experience with endovascular control of aCBS in patients treated for HNC. We review the characteristics, pathology, endovascular treatment and morbidity and assess the gain in life years. Results Nine individuals were included in this study. Four patients had been previously diagnosed with laryngeal squamous cell carcinoma (SCC), one with paranasal SCC, one with nasopharyngeal carcinoma and three with oral or maxillary adenocarcinoma. All subjects underwent radiotherapy and surgical excision to different extents. Twelve endovascular procedures were performed for injuries to the internal carotid artery (n = 3; 25%), external carotid artery (n = 1; 7%) or one of their branches (n = 8; 67%). Deconstructive methods were used in nine procedures, and three procedures were mainly reconstructive with deployment of covered stents. Total control of bleeding was achieved in all individuals with no intraprocedural complications. Conclusion Endovascular therapy is an effective alternative for the management of exsanguinating CBS. In our series, this palliative therapy increased the overall patient survival by an estimated 9 months.

Case Report: Life Threatening Bleeding following Maxillofacial Injury

2002 ◽  
Vol 9 (1) ◽  
pp. 42-45
Author(s):  
Kl Tsui ◽  
Hh Yau ◽  
Cw Kam
Keyword(s):  
Emergency Medicine ◽  
Carotid Artery ◽  
Haemorrhagic Shock ◽  
External Carotid Artery ◽  
External Carotid ◽  
Airway Compromise ◽  
Carotid Angiography ◽  
Maxillofacial Injury ◽  
Severe Haemorrhage ◽  
Life Threatening

Maxillofacial injury is commonly seen in the practice of emergency medicine. Major maxillofacial injury itself can be life threatening. Apart from the danger of potential airway compromise, severe haemorrhage from branches of carotid artery causing haemorrhagic shock can occur. Blind techniques, such as packing or ligation of external carotid artery are the usual methods employed to stop the bleeding. However blind techniques carry a significant failure rate. A patient with severe maxillofacial injury and torrential haemorrhage is reported. The bleeding could not be controlled by oral and nasal packing. Emergency selective carotid angiography was performed to identify the source of bleeding and embolization of the bleeding branches successfully arrested the haemorrhage. Interventional radiology could be as effective, if not superior, as an operation in controlling bleeding in selective cases.

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