Treatment of Recurrent Epistaxis in HHT

Geisthoff, Urban; Fiorella, Maria Luisa; Fiorella, R

doi:10.2174/138161206776361255

Cited by 27 publications

(34 citation statements)

References 41 publications

(77 reference statements)

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“…[2][3][4]7,10,11 The most widely used treatments can be divided into four major groups: elimination of telangiectasia, reduction of blood flow, reduction of trauma and improvement of protection. 9 The first group includes laser ablation, argon plasma coagulation and radiofrequency. Laser coagulation is a non-invasive procedure and there are different forms of laser photocoagulation including the argon, KTP and Nd:YAG laser.…”

Section: Discussionmentioning

confidence: 99%

“…4,9,10 Patients with more severe forms of the disease, requiring multiple blood transfusions, seem to benefit less from this treatment. 9 There are few studies comparing the effectiveness of different types of laser, however the efficacy of Nd:YAG, KTP and argon lasers seems to be similar, with a higher risk of septal perforation with Nd:YAG.…”

Section: Discussionmentioning

confidence: 99%

“…2,7,9 This system has been presented as an alternative to the Nd:YAG laser, as coagulation and dissection of tissue are limited to a depth of 1 to 2 mm. The risk of tissue damage and septal perforation are lower.…”

Section: 49mentioning

confidence: 99%

“…3,8,11,12 The group of treatments that decrease the blood flow includes nasal packing, angiographic embolization and arterial ligation. 9 We also include in this group the topical hemostats.…”

Section: 49mentioning

confidence: 99%

“…2,4,5 Epistaxis is the most common and earliest symptom. 1,[4][5][6][9][10][11] It is usually mild to moderate, however, in some patients it can be severe leading to significant impact on quality of life and requiring regular blood transfusions. 1,4,10,11 Although there is no definitive treatment, various treatments for epistaxis in HHT have been proposed.…”

Section: Introductionmentioning

confidence: 99%

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Radiofrequency for Treatment of Refractory Epistaxis in Hereditary Hemorrhagic Telangiectasia

et al. 2018

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Hereditary hemorrhagic telangiectasia is a rare multi-systemic autosomal dominant disorder characterized by dysplasia of the vascular connective tissue and recurrent bleeding tendency. Epistaxis is the most common and earliest symptom. It is usually mild to moderate, however, in some patients it can be severe with significant interference in quality of life. We report a case of a patient with hereditary hemorrhagic telangiectasia, in which an episode of refractory epistaxis was treated with radiofrequency and fibrin sealant. Control of acute bleeding and elimination of telangiectasia was possible with this technique. After six months follow-up, there was no epistaxis recurrence. Various treatments for epistaxis in this disease have been described in the literature, but there is no consensus about the gold-standard procedure. Radiofrequency ablation of telangiectasia is a recent technique that has shown to be safe, effective and well tolerated, even in patients who underwent other previous treatments. Keywords: Epistaxis; Radiofrequency; Telangiectasia, Hereditary Hemorrhagic RESUMO A telangiectasia hemorrágica hereditária é uma doença autossómica dominante, multissistémica e rara, caracterizada pela displasia do tecido conectivo vascular com tendência à hemorragia recorrente. O sintoma mais comum e precoce é a epistaxis. Habitualmente é ligeira a moderada, no entanto, em alguns doentes, pode ser severa com interferência significativa na sua qualidade de vida. É reportado o caso de um doente com telangiectasia hemorrágica hereditária, em que um episódio de epistaxis refractária foi tratado com radiofrequência e um quelante de fibrina. Com esta técnica foi conseguido não só o controlo da hemorragia activa, mas também a eliminação das telangiectasias. Após seis meses de seguimento, não houve recorrência da epistaxis. Há vários tratamentos descritos na literatura para a epistaxis nesta doença, não havendo no entanto, consenso acerca do gold standard. A ablação com radiofrequência das telangiectasias é uma técnica recente que se tem mostrado segura, eficaz e bem tolerada, mesmo em doentes submetidos previamente a outros tratamentos.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: 49mentioning

confidence: 99%

Section: 49mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiofrequency for Treatment of Refractory Epistaxis in Hereditary Hemorrhagic Telangiectasia

et al. 2018

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Office‐based sclerotherapy for recurrent epistaxis due to hereditary hemorrhagic telangiectasia: a pilot study

Boyer

Fernandes

Durán

et al. 2011

Int Forum Allergy Rhinol

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

Boyer

Fernandes

et al. 2015

Int Forum Allergy Rhinol

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Background Our previous studies have demonstrated the tolerability and low side-effect profile of office-based sclerotherapy with sodium tetradecyl sulfate (STS) for treating recurrent epistaxis due to hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to use a prospective randomized trial to determine the effectiveness of sclerotherapy with STS vs standard treatment. Methods This prospective randomized trial (conducted from November 1, 2011, through January 31, 2014) involved 17 patients with recurrent epistaxis due to HHT. We defined standard treatment as continuation of any treatment that the patient had previously undergone, such as moisturization, packing, and cautery. We used a crossover design, so study participants were randomized to either sclerotherapy or standard treatment during the first time period, and then to the other during the second period. The primary outcome measure was frequency and severity of epistaxis, as measured by the epistaxis severity score (ESS). The ESS is a 10-point scale, with higher scores corresponding to more bleeding. Results After controlling for treatment order, bleeding was substantially better controlled after sclerotherapy; the ESS after sclerotherapy was nearly one point lower than after standard treatment (−0.95, 1-sided p = 0.027). Treatment order, baseline ESS, the number of lesions, moisturization practices, and a history of previous blood transfusions did not significantly affect the results. Conclusion This trial demonstrated that sclerotherapy with STS (vs standard treatment) significantly reduced epistaxis due to HHT.

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Treatment of Recurrent Epistaxis in HHT

Cited by 27 publications

References 41 publications

Radiofrequency for Treatment of Refractory Epistaxis in Hereditary Hemorrhagic Telangiectasia

Radiofrequency for Treatment of Refractory Epistaxis in Hereditary Hemorrhagic Telangiectasia

Office‐based sclerotherapy for recurrent epistaxis due to hereditary hemorrhagic telangiectasia: a pilot study

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

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