Endovascular Treatment of Epistaxis

Abstract

SUMMARY:Epistaxis is a common condition that can be managed conservatively in most cases. When these measures, including anterior and posterior packing of the nasal cavity, are unsuccessful at controlling the bleeding, interruption of the blood supply to the sinonasal area can be performed, either by surgical ligation or by transarterial embolization. Embolization should be preceded by thorough diagnostic angiography. Aside from aiding with subsequent selective catheterization and embolization, such angiography may reveal significant anatomic anomalies, anastomoses, or an unsuspected cause of epistaxis. Taking these findings into account, the interventionalist may decide to refrain from embolization or adjust the technique to minimize the risk of adverse events, which are mostly related to inadvertent embolization of the internal carotid artery or ophthalmic artery. We present a review of the various causes of epistaxis and the treatment options, with emphasis on endovascular embolization. We also describe the protocol of our institution for endovascular management of this condition.

Cost-effectiveness Analysis of Endoscopic Sphenopalatine Artery Ligation vs Arterial Embolization for Intractable Epistaxis

“…The traditional treatment strategy of posterior nasal packing has been largely replaced by the more effective and less morbid techniques of transnasal endoscopic sphenopalatine artery ligation (TESPAL) [1][2][3] and endovascular arterial embolization. [4][5][6] Furthermore, a recent study by Dedhia et al 7 suggested that TESPAL is the most cost-effective strategy compared with posterior nasal packing. The success rates for both TESPAL and embolization is estimated to be greater than 90%, and therefore the decision to choose one modality over another can be challenging.…”

Angioembolisation in Maxillofacial Trauma: An Initial Experience in a Tertiary Care Center

“…Angioembolisation has been an accepted technique in the management of refractory epistaxis [3,4]. It is especially sought in cases of posterior epistaxis, which fails to respond to nasal packing and medical measures.…”

“…Embolising agents used to treat traumatic oro-nasal bleeding includes pledgets of gelatin sponge and stainless steel or platinum coils [3,12]. Gel foam particles are the most commonly used embolising agents.…”

Off-Label Use of Drugs and Devices in the Neuroendovascular Suite

“…110, 111 The complication rates and success of embolization or surgical ligation are similar, though embolization is associated with more major complications when embolic agents inadvertently enter the internal carotid or ophthalmic artery.…”