Principles of interventional treatment in epistaxis

Abstract

Epistaxis is acommon ear, nose, and throat emergency, but rarely adirect cause for hospital admission. Patients who receive inpatient treatment usually suffer from recurrent posterior epistaxis. Despite otolaryngologic measures such as posterior packing or surgery, bleeding may recur or continue or the source may not be surgically accessible. For these patients, endovascular therapy is a real, sometimes the only, treatment option. In addition to idiopathic causes of posterior epistaxis, the cause may also be symptomatic. In this case, the cause must be identified and treatment adapted accordingly. Pre-embolization CT of the paranasal sinuses and CT-angiography is useful. These methods can reveal the cause and location of the hemorrhage as well as significant vessel variants, anatomic anomalies, or an unsuspected cause of epistaxis. Overall, with a good understanding of the dangerous anastomoses, endovascular therapy for posterior epistaxis has high success rates with alow periprocedural risk.