Epistaxis: The role of arterial embolization

Abstract

Epistaxis is defined as flow of blood from the nasal fossae and is a common and benign disorder in the great majority of cases which does not require medical care. It may however become a genuine medical or surgical emergency because of the amount, repeated episodes or patient's medical vulnerability (such as coronary artery disease patients). Epistaxis may be either primary or a symptom of an underlying disease. Four levels of problems need to be answered faced with epistaxis: recognizing it, and in particular not missing "epistaxis" due to swallowed blood or venous hemorrhage, which falls outside of the scope of interventional radiology; establishing the amount and its repercussions, particularly as a decompensating factor in another disease; investigating its cause and in particular never missing a tumor (male adolescents); obtaining hemostasis. Epistaxis varies not only in type and cause but must be considered in its clinical context. Arterial embolization is a treatment of choice for severe refractory epistaxis and some hemorrhages. When carried out by trained operators, it is an effective method with few risks of complications and is increasingly being used in reference centers (Brinjikji et al.). It remains, however, a method which is less widely used than surgery, particularly in the United States where in a series of 69,410 patients treated over the last 10 years for refractory epistaxis, 92.6% underwent surgical ligation, 6.4% embolization and 1% combined treatments (Brinjikji et al.). Epistaxis is occasionally catastrophic and requires extremely urgent management. In each case, close collaboration with the surgeon, the presence of an intensive care anesthetist and at least sedation are all factors which improve management and therefore the results of embolization. All patients and/or their friends/close family should have given "reliable, clear and appropriate" information.

Sphenopalatine artery surgery for refractory idiopathic epistaxis: Systematic review and meta‐analysis

“…It may cause major complications, such as blindness and soft tissue ischemia . There is a risk of systemic complications, including inhalation hypoxia, hypovolemia, angina, and myocardial infarction . However, recent advances in techniques and surgical devices have led to fewer complications, as well as enhanced success rates (71%–94%) .…”

“…The pooled total rebleeding rate of cauterization was 7.2% (95% CI 4. [6][7][8][9][10][11]. Conversely, the rate in ligation procedures was 15.1% (95% CI, 9.8-22.5).…”

“…39 There is a risk of systemic complications, including inhalation hypoxia, hypovolemia, angina, and myocardial infarction. 8 However, recent advances in techniques and surgical devices have led to fewer complications, as well as enhanced success rates (71%-94%). 7,39,40 An advantage of embolization is the detection of variations in vascular anatomy; further, multiple arteries can be occluded.…”

“…Further, it may involve serious complications, such as necrosis of soft palatine tissue, facial paresis, and blindness . Systemic complications also may occur, including inhalation hypoxia, hypovolemia, angina, and myocardial infarction . Sphenopalatine surgery was once an extremely difficult method.…”

“…7 Systemic complications also may occur, including inhalation hypoxia, hypovolemia, angina, and myocardial infarction. 8 Sphenopalatine surgery was once an extremely difficult method. Endoscopic surgery has made progress with the improvement of instruments available for surgery.…”