Endovascular Stenting for Prevention of Arterial Blowout in Patients with Advanced Vulvar Cancer

Elyse N. Brock

doi:10.1016/j.jpainsymman.2024.02.231

1. Identify when endovascular stenting to decrease the risk of arterial rupture may be appropriate, based on prognosis and goals of care, in patients with advanced vulvar cancer. 2. Name possible reasons why endovascular stenting in patients who are at risk of iliac/femoral artery rupture may be less common than endovascular stenting in patients who are at risk of carotid artery rupture. While there is significant literature regarding carotid blowout, and endovascular stenting to decrease this risk in patients with head/neck cancer, there is sparse data regarding stenting to decrease the risk of pelvic/groin artery blowout in patients with vulvar cancer. We present two patients with advanced vulvar cancer who underwent endovascular stenting to decrease their risk of arterial blowout. Rupture of the iliac arteries or their major branches is a rare, but often traumatic and fatal, complication of advanced vulvar cancer. Predisposing factors include prior radiation therapy, prior surgery, wound breakdown, wound infection, tumor recurrence and vessel exposure. While there is significant literature regarding extracranial carotid artery rupture (i.e. carotid blowout), and endovascular stenting to decrease the risk of this occurrence in patients with advanced head and neck cancers, there is sparse data regarding endovascular stenting to decrease the risk of iliac/femoral artery rupture in patients with advanced vulvar cancer. Although endovascular stenting is commonly performed as a preventative measure in patients with "threatened carotid blowout syndrome", i.e. in cases where physical exam or imaging findings - such as an exposed artery - suggest a high likelihood of arterial rupture without prompt intervention, it is not commonly performed in patients who are at risk of iliac/femoral artery rupture. We present this case series of two patients with advanced vulvar cancer - one with exposed right femoral vessels and another with exposed right external iliac vessels - who underwent angiogram with coil embolization and endovascular stenting in an effort to decrease their risk of arterial rupture and acute hemorrhage. We review their oncologic histories, physical exam findings, imaging and procedure reports, post-procedural experiences and outcomes. We discuss when endovascular stenting may be appropriate, based on prognosis and goals of care, in other patients with advanced vulvar cancer. We consider possible reasons why endovascular stenting in patients who are at risk of iliac/femoral artery rupture may be less common than endovascular stenting in patients who are at risk of carotid artery rupture. Surgical Palliative Care / Disease specific management

Endovascular Stenting for Prevention of Arterial Blowout in Patients with Advanced Vulvar Cancer

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