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Endovascular Treatment of Epistaxis: Indications, Management, and Outcome

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Abstract

Objective

Epistaxis is a common clinical problem, and the majority of bleedings can be managed conservatively. However, due to extensive and sometimes life-threatening bleeding, further treatment, such as superselective embolization, may be required. We report our experience with endovascular treatment of life-threatening epistaxis.

Methods

All patients presenting with excessive epistaxis, which received endovascular treatment at a German tertiary care facility between January 2001 and December 2009, were retrospectively identified. Demographic data, etiology, origin and clinical relevance of bleeding, interventional approach, therapy-associated complications, and outcome were assessed.

Results

A total of 48 patients required 53 embolizations. Depending on the etiology of bleeding, patients were assigned to three groups: 1) idiopathic epistaxis (31/48), 2) traumatic or iatrogenic epistaxis (12/48), and 3) hereditary hemorrhagic telangiectasia (HHT) (5/48). Eleven of 48 patients required blood transfusions, and 9 of these 11 patients (82%) were termed clinically unstable. The sphenopalatine artery was embolized unilaterally in 10 of 53 (18.9%) and bilaterally in 41 of 53 (77.4%) procedures. During the same procedure, additional vessels were embolized in three patients (3/53; 5.7%). In 2 of 53(3.8%) cases, the internal carotid artery (ICA) was occluded. Long-term success rates of embolization were 29 of 31 (93.5%) for group 1 and 11 of 12 (91.7%) for group 2 patients. Embolization of patients with HHT offered at least a temporary relief in three of five (60%) cases. Two major complications (necrosis of nasal tip and transient hemiparesis) occurred after embolization.

Conclusions

Endovascular treatment proves to be effective for prolonged and life-threatening epistaxis. It is easily repeatable if the first procedure is not successful and offers a good risk–benefit profile.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Katharina Strach, Kai Wilhelm, Susanne Greschus, Henriette Tschampa, Markus Möhlenbruch, Claas P. Naehle, Hans H. Schild & Horst Urbach

  2. Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Katharina Strach

  3. Department of Otorhinolaryngology—Head and Neck Surgery, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Andreas Schröck, Mark Jakob, Andreas O. H. Gerstner & Friedrich Bootz

Authors
  1. Katharina Strach
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  2. Andreas Schröck
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  3. Kai Wilhelm
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  4. Susanne Greschus
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  7. Claas P. Naehle
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  9. Andreas O. H. Gerstner
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  10. Friedrich Bootz
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  11. Hans H. Schild
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Corresponding author

Correspondence to Horst Urbach.

Additional information

Katharina Strach and Andreas Schröck contributed equally to this work.

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Strach, K., Schröck, A., Wilhelm, K. et al. Endovascular Treatment of Epistaxis: Indications, Management, and Outcome. Cardiovasc Intervent Radiol 34, 1190–1198 (2011). https://doi.org/10.1007/s00270-011-0155-5

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  • DOI: https://doi.org/10.1007/s00270-011-0155-5

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