Complications from office sclerotherapy for epistaxis due to hereditary hemorrhagic telangiectasia (HHT or Osler‐Weber‐Rendu)

Abstract

Conventional therapies used in the management of HHT-related epistaxis, such as laser coagulation, septodermoplasty, selective arterial embolization, and Young's occlusion each have specific associated complications, including worsened epistaxis, septal perforation, foul odor, nasal crusting, and compromised nasal breathing. STS is a safe office-based treatment option for HHT-mediated epistaxis that is associated with exceedingly few of the aforementioned serious sequelae.

Prospective randomized trial of sclerotherapy vs standard treatment for epistaxis due to hereditary hemorrhagic telangiectasia

“…These results confirm the findings from our previously published retrospective analyses, which demonstrated substantial improvement without perforation, crusting, or foul smell in the near‐term and at longer‐term follow‐up of 36 patients . However, it should be emphasized that potential complications related to the sclerosant traveling to unintended sites must be thoroughly considered.…”

“…All 7 were willing to undergo sclerotherapy with STS again . In our subsequent analysis of outcomes in 36 patients undergoing repeated sclerotherapy, we found no reports of adverse sequelae such as septal perforation, increased bleeding, or foul smell; some patients described minimal transient procedural symptoms, but no serious complications …”

Hereditary haemorrhagic telangiectasia

“…Various subjective grading systems are available (35,36) , and objective classification of the pattern of lesions has also been described (37) . Nasal telangiectasia are tortuous dilated superficial vessels (Figure 1), very sensitive to even the minor trauma of airflow, and a lack of elastin fibres means that they do not vasoconstrict to limit bleeding (38) .…”

“…Submucosal bipolar radiofrequency causes submucosal sclerosis with preservation of the overlying mucosa, and a small pilot study showed a significant reduction in HHT-related epistaxis when applied to the nasal septum (100) . Submucosal injection of various sclerosants directly into septal and lateral nasal wall lesions has also been used with some success (28,38,101) , under both local and general anaesthesia.…”

Editorial

“…Patients with hereditary hemorrhagic telangiectasia (HHT) represent a recurring therapeutic challenge. Investigators from the radiology department and the otolaryngology department at the University of Minnesota present their experience using in office sclerotherapy in 36 patients undergoing an average of over 4 sessions each . Seven patients had bleeding less than 50mL and one patient experienced a blood loss of 200 mL.…”