Endovascular Embolization for Control of Post-Tonsillectomy Hemorrhage

Abstract

Windsor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The underrated role of cold drinks in post-tonsillectomy care: a pediatric case study

“…As it is not a perfect treatment alone, according to a previous study, postoperative vessel embolization [10] and intraoperative bupivacaine injection [11] are possible measures to reduce postoperative bleeding and pain. Thorough preoperative planning and consideration of those measures are necessary to minimize postoperative complications.…”

Ascending Palatine Artery Embolization for the Treatment of Surgically Refractory Post-tonsillectomy Hemorrhage

“…Depending on the severity of post-tonsillectomy hemorrhage, initial management is usually observation or surgical intervention. Various surgical hemostasis techniques include the application of direct pressure to the bleeding site, topical hemostatic agent application, electrocautery, suturing of the tonsillar pillars, and surgical reexploration and ligation of bleeding vessels arising from the external carotid artery [ 5 , 6 ]. Success rates of surgical hemostasis after a first failed surgical procedure are low, about 50% for the second surgical procedure and 67% for the third [ 2 ].…”

“…Evidence for endovascular embolization of the branches of the external carotid artery as an effective treatment for severe post-tonsillectomy hemorrhage when attempts at surgical control have failed has been growing [ 2 - 5 , 7 , 8 ]. Endovascular embolization has several advantages, including: (1) the diagnostic angiographic assessment and subsequent intervention can be performed during the same procedure, (2) treatment can be targeted to one of the feeding arteries of the tonsillar fossa, as described in our case, (3) significantly shorter length of hospitalization, and (4) lower red blood cell transfusions during and post-procedure [ 2 - 5 ]. Nonetheless, endovascular embolization has its own risks.…”

“…Nonetheless, endovascular embolization has its own risks. Potential risks of endovascular embolization include catheter-or wire-induced vasospasm, vessel perforation leading to extravasation of embolic material, ischemic injury to the mucosal surface and cranial nerves, inadvertent embolization of the internal carotid artery branches, and femoral artery injuries, including dissection, pseudoaneurysm, or rupture [ 4 , 5 ]. Various embolic materials, including coils, polyvinyl alcohol particles, and n-butyl-2-cyanoacrylate (NBCA) glue have been used for embolization [ 2 - 5 , 7 , 8 ].…”

“…The efficacy of surgical interventions tends to decline with repetition, which leads to higher morbidity and mortality [ 2 ]. Evidence for endovascular embolization of the branches of the external carotid artery as an effective treatment for severe surgically refractory post-tonsillectomy hemorrhage has been growing [ 2 - 5 ]. We describe the case of a 27-year-old man who presented with surgically refractory post-tonsillectomy hemorrhage and underwent successful endovascular embolization of the ascending palatine artery with immediate hemostasis.…”