Endovascular treatment of epistaxis in patients irradiated for nasopharyngeal carcinoma.

Abstract

Posterior epistaxis commonly occurs after radiotherapy for nasopharyngeal carcinoma and is difficult to treat. Endovascular treatment was carried out on 11 previously irradiated patients who presented with intractable epistaxis over 4 years. We review their outcomes. All had significant angiographic abnormalities. Ten patients underwent intra-arterial embolization and, in one patient, balloon occlusion of an arterial pseudo-aneurysm was performed. Two patients (18%) suffered permanent neurological deficits. Two (18%) required further embolization in the first 2 days and one (9%) after the first month. One patient (9%) is still alive 4 years later. Only three (27%) died from haemorrhage. The mean survival duration after treatment was 225 days. Post-radiation anatomical changes often make conventional treatment of epistaxis difficult. Endovascular treatment maps out aberrant vascular anatomy and identifies the offending vessel. Our results show that the survival benefit of this treatment outweighs the risks, as such haemorrhage is often fatal.