Minimally invasive surgical techniques for hemostasis in Osler–Weber–Rendu disease

Abstract

Abstract Introduction Osler–Weber–Rendu disease, also called “hereditary hemorrhagic telangiectasia” (HHT), is an autosomal dominant genetic disorder characterized by the appearance of small disseminated vascular malformations in the skin, mucous membranes and organs (lungs, brain, liver) with repeated bleeding tendency. Most common symptom is epistaxis. Argon plasma coagulation (APC) is an on-contact electrosurgical monopolar thermal procedure used for achieving hemostasis. The principle of this method consists in transferring energy to a target tissue via plasma, the fourth fundamental state of matter. To achieve coagulation, argon (an inert, non-toxic gas) is delivered through a probe and ionized by a discharge current elective high voltage. Electrical energy is transferred to the tissue through the argon plasma. Aim The authors present a clinical case of a HHT where a minimally invasive surgical technique based on APC proved to be effective for controlling repeated bleeding of nasal origin. Case study We present the case of P.L. patient, aged 71, from rural environment, presented to the emergency room of our clinic for active bilateral anterior epistaxis. The patient reports a long history of the pathology, starting approximately 23 years ago and characterized by the existence of frequent episodes of recurrent epistaxis. Results and discussion Immediate and late postoperative results are presented and compared. The APC proved to be effective both in the short and long term, in increasing bleeding-free interval, and in decreasing the frequency and intensity of episodes of nasal bleeding origin. Conclusions The presented clinical case with favorable outcome highlights the role of a modern surgical technology – APC – effective in achieving nose hemostasis. In the presented case, APC has brought many advantages in achieving hemostasis: non-contact coagulation with minimal tissue penetration and destruction, a safe method with minimal complications, decreased risk of perforation.