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Objective:
Extension of head and neck malignancies into major blood vessels can complicate patient management. Our study examined the multidisciplinary approach to the treatment of advanced head and neck cancer.
Methods:
We performed a retrospective review of cancer patients treated by head and neck surgery (HNS) and vascular surgery from 2007-2014. Data concerning history of cancer and radiation therapy, operative interventions, and perioperative morbidity and mortality was collected.
Results:
31 patients with head and neck cancer were operated on by HNS and required vascular intervention. Vascular surgery intervention was synchronous (23) or metachronous (8) to the associated cancer procedure. Post-resection interventions occurred at an average of 4 years (41 days- 14 years). 25 patients (81%) had recurrent disease, of which 24 had previous radiation therapy and 14 had prior resection. 22 patients (71%) had flap coverage. 7 patients (23%) required emergent as opposed to elective intervention, all for bleeding. Indications for vascular intervention were invasion/encasement of major vasculature (17), bleeding/blowout (8), stenosis/occlusion (3), and aneurysm/pseudoaneursym (3).
32 index operations were performed: Exploration/dissection in 8 patients (4 bilateral carotid arteries (CCA), 3 unilateral CCA, 1 innominate artery). Resection in 17 patients: 9/17 without reconstruction (7 external carotid artery (ECA), 1 internal carotid artery (ICA), 1 CCA) and 8/17 with reconstruction (6 CCA to ICA bypasses, 1 innominate/SCA bypass, 1 innominate to axillary vein bypass). 6 patients received stents (5 CCA/ICA and 1 innominate). 1 patient had an angioembolization (ECA).
6 patients (19%) required reintervention after index vascular procedure. (see Table 1)
There were three 30-day mortalities (9.7%), all from blowout. Based on Kaplan Meyer analysis, bypass and stent primary patency at 1 year was 67% and 100%, respectively. Survival at 1 and 2 years post vascular intervention was 62% and 19%, respectively. A significant increase in mortality (7 vs 22 months, p=0.06) and 30-day mortality rate (43% vs 0%) was noted in emergent versus elective cases.
Conclusions:
Vascular involvement in head and neck cancer indicates advanced disease, commonly in patients who have had previous RT. Nonetheless, vascular intervention is feasible. Optimal treatment of these patients requires a multidisciplinary approach.
Table

Patient #	Index Procedure	Indication for Reintervention	Reintervention
5	Bilateral Carotid Dissection	Blowout	R CCA/ICA stent, re-stenting, embolization of CCA
9	R CCA bypass with RSVG	Thrombosis	Open thrombectomy with vein patch repair
12	L CCA/ICA stent with ECA embolization	Re-exploration per HNS	Ligation of ECA with patch angioplasty of CCA
13	L CCA bypass with RSVG	Blowout	Ligation of CCA
16	Resection of R ECA	L Lingual PSA	Angiography, thrombin injection
19	R carotid exploration with ECA resection	Bleeding	Diagnostic angiography