Assessment of safety and efficacy of arterial embolisation in the management of intractable epistaxis

Abstract

To evaluate outcomes of intractable epistaxis managed with arterial embolisation. Fourteen sequential cases of intractable epistaxis that underwent embolisation in our centre were evaluated retrospectively and interviewed over the phone. All patients had several failed treatment modalities prior to embolisation. Patients' follow up ranged from 1 to 57 months with median of 26 months. All 14 cases underwent a single embolisation procedure with successful arrest of epistaxis. Four cases (29%) developed recurrent epistaxis at a later date. One (7%) required re-embolisation 19 months after his first procedure. One bled 17 days after embolisation, but this settled with hospital admission and Bismuth Iodoform Paraffin Paste packing. The other two developed minor episodes of epistaxis, which did not require hospital admission. Two patients developed local ischaemic complications following arterial embolisation. Of those, one developed necrosis of the left alar skin and cartilage that healed reasonably well after 5 months. The other case developed mucosal necrosis of the right side of the hard palate; this patient was the one who bled 17 days post-embolisation. The palatal necrosis healed in a satisfactory manner without causing any functional impairment of the oral cavity. Embolisation is a successful intervention in management of persistent epistaxis, when other interventions fail. The risks of major complications such as stroke are well known, and discussed with patients prior to the procedure. It is also important to discuss the risks of ischaemic damage to the face and oral cavity. In our experience, these complications have been minor and the benefits still outweigh the complications.

Endovascular Treatment of Epistaxis

“…20,23,25,29,31,33 When early rebleeds were taken into account, the success rate dropped to 77.3%-94.6%. 19,20,25,28,29,32,33 The period evaluated for these rebleeds varied from 72 hours 28 to 33 days.…”

“…29 Retrospective reviews that took late rebleeds into account reported a further drop in the success rate to 71%-89.2%. 19,20,25,29,[31][32][33] One group clearly demonstrated that the success rate depended on the embolization protocol used. 23 Another report demonstrated the influence of the underlying pathology on the short-term and long-term success rates, with long-term success naturally being lowest in patients with HHT, because these patients have ongoing systematic pathology resulting in new episodes.…”

“…19,20,25,29,33 Major transient complications include skin slough, 19 temporary hemiparesis, 20,23 temporary monocular visual field loss, 28 and mucosal necrosis. 31,69 Persistent complications include facial scarring following ischemia, 31 monocular blindness, 27 peripheral facial nerve paralysis, 28,70 cerebral infarction, 19,20,29 and ischemic sialadenitis requiring surgery. 24 Larger series report minor transient complications in 25%-59%, major transient in 0%-1%, and persistent in Յ2% of cases.…”

“…Smaller particles (50 -150 m) are also discouraged because they are more likely to enter dangerous anastomoses. Thus, most recent reports mention the use of PVA particles, [27][28][29][30][31][32] usually between 150 and 500 m, with or without the subsequent addition of Gelfoam sponge pledgets or platinum coils. 29,32 The literature is inconsistent with regard to the timing of AP pack removal.…”

Superselective Microcatheter Embolization of Hemorrhage after Buccal Lipectomy

“…Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the The use of superselective microcatheter angiography and embolization is a known modality for prompt treatment of bleeding from traumatic facial injury [1,2] and refractory epistaxis [3,4] when local methods fail. Despite this successful profile, its use in treatment of hemorrhagic complications after facial aesthetic surgery is underreported.…”