Management Of Intractable Epistaxis Research Articles

Management of intractable epistaxis in a tertiary care referral hospital: an observational study

Management of intractable epistaxis in a tertiary care referral hospital: an observational study

Transnasal Endoscopic Sphenopalatine Artery Ligation Compared With Embolization for Intractable Epistaxis: A Long-term Analysis

Background Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and selective embolization both provide excellent treatment success rate in the management of intractable epistaxis. Few long-term studies comparing these approaches have been previously published. Recommendations often present these techniques as alternatives, but there is no clear consensus. Objective The purpose of this study was to evaluate and compare the clinical efficacy of sphenopalatine artery ligation versus embolization to control intractable epistaxis. Methods We performed a retrospective study including all patients referred to our tertiary medical center for severe epistaxis and treated by surgical ligation and/or embolization. The patients were classified into 2 groups: those who underwent TESPAL only and those who underwent endovascular embolization only. We evaluate and compare long-term clinical outcomes after surgical ligation or embolization for the control of intractable epistaxis in terms of effectiveness (recurrence rate) and safety (complication rate). Results Forty-one procedures of supraselective embolization and 39 procedures of surgical ligation for intractable epistaxis are reported and analyzed. No significant difference was observed between the groups in terms of demographic factors, comorbidities, or average length of hospital stay. The 1-year success rate was similar (75%) in both groups. Complications (minor and/or major) occurred in 34% cases in the embolization group and in 18% in the surgical group ( P = .09, ns). Bilateral embolization including facial artery was the only treatment method associated with a significant risk of complications ( P = .015). Conclusion TESPAL seems to provide a similar control rate with a decrease in the number of complications compared to selective embolization in the context of intractable epistaxis. Further studies are required.

Transarterial embolization in the management of intractable epistaxis: the angiographic findings and results based on etiologies

Conclusions: Transarterial embolization (TAE) appears to be a safe and effective treatment for patients with intractable epistaxis, despite different etiologies or angiography findings. Idiopathic epistaxis is prone to present with negative angiographic findings. Objective: To retrospectively evaluate the safety and effectiveness of TAE for intractable epistaxis, and focus on the factors of etiology and angiographic findings. Materials and methods: From March 2008 to December 2014, the data of 43 patients with intractable bleeding undergoing TAE were reviewed. The outcomes of interventional therapy were assessed according to different etiology (malignant or benign disease) and angiographic finding (positive or negative angiogram). Results: Positive angiographic findings were found in 11 of 12 cases with malignant diseases and 22 of 31 cases with benign diseases, respectively (p = 0.237). Among the 10 cases with negative angiographic findings, the negative angiography rate of idiopathic epistaxis was higher than that of epistaxis with definite etiology (p = 0.003). Bleeding was controlled successfully in all of the 43 patients after embolization. During the mean follow-up period of 24.0 ± 16.7 months, five patients relapsed. No significant difference was found in recurrence rates between malignant and benign diseases or between positive and negative angiography (p = 0.241, p = 0.704, respectively).

Management of intractable epistaxis in patients who received radiation therapy for nasopharyngeal carcinoma

To report clinical manifestations, bleeding point localization, and outcomes of management in 16 patients with 16 instances of intractable epistaxis after radiation therapy for nasopharyngeal carcinoma. Retrospective chart review of 16 patients with nasopharyngeal carcinoma (mean age 52.06 ± 14.37 years) with 16 instances of intractable epistaxis during the past 5 years, whose diagnosis was confirmed by angiography (n = 10) or MRI/CT imaging studies and clinical manifestations (n = 6). The mean radiation dose to the affected carotid artery was 101.37 ± 34.85 Gy. Bleeding points were detected in the internal carotid artery (n = 8) or external carotid artery (n = 8). Detachable balloons were used in one affected artery for vascular occlusion; six were treated using an absorbable gelatin sponge (n = 4) or microcoils (diameter 1 mm) (n = 2). Endovascular embolization was successful in seven radiation carotid blowout syndromes with cessation of hemorrhage. One patient underwent external carotid artery ligation and one patient recovered without treatment. The clinical follow-up was 3 months. Therapeutic endovascular embolization of intractable epistaxis is both efficient and safe. It should be considered as the primary treatment modality in intractable epistaxis of nasopharyngeal carcinoma.

Management of intractable epistaxis: endoscopy or nasal packing?

To investigate common origins of intractable epistaxis, and the efficacy of endoscopic management. Retrospective study of 265 patients with uncontrolled idiopathic epistaxis presenting between July 2008 and July 2009. Patients underwent endoscopic examination and subsequent radiofrequency electrocautery, selective packing or observation. Nasal endoscopy indicated that the commonest bleeding sources were the superior nasal septum at the olfactory cleft (39.2 per cent), the inferior meatus (27.5 per cent), the sphenoethmoid recess (6.0 per cent), the middle meatus (5.3 per cent) and other locations (3.4 per cent). Bleeding was successfully controlled with nasal endoscopy plus radiofrequency electrocautery or selective packing. In 49 (18.5 per cent) patients, no abnormality was identified; these patients received observation only, and no further bleeding occurred. None of the patients had serious complications or recurrent epistaxis during the three-month follow-up period. Thorough endoscopic examination combined with radiofrequency electrocautery should be used as first-line therapy for intractable epistaxis.

Assessment of safety and efficacy of arterial embolisation in the management of intractable epistaxis

To evaluate outcomes of intractable epistaxis managed with arterial embolisation. Fourteen sequential cases of intractable epistaxis that underwent embolisation in our centre were evaluated retrospectively and interviewed over the phone. All patients had several failed treatment modalities prior to embolisation. Patients' follow up ranged from 1 to 57 months with median of 26 months. All 14 cases underwent a single embolisation procedure with successful arrest of epistaxis. Four cases (29%) developed recurrent epistaxis at a later date. One (7%) required re-embolisation 19 months after his first procedure. One bled 17 days after embolisation, but this settled with hospital admission and Bismuth Iodoform Paraffin Paste packing. The other two developed minor episodes of epistaxis, which did not require hospital admission. Two patients developed local ischaemic complications following arterial embolisation. Of those, one developed necrosis of the left alar skin and cartilage that healed reasonably well after 5 months. The other case developed mucosal necrosis of the right side of the hard palate; this patient was the one who bled 17 days post-embolisation. The palatal necrosis healed in a satisfactory manner without causing any functional impairment of the oral cavity. Embolisation is a successful intervention in management of persistent epistaxis, when other interventions fail. The risks of major complications such as stroke are well known, and discussed with patients prior to the procedure. It is also important to discuss the risks of ischaemic damage to the face and oral cavity. In our experience, these complications have been minor and the benefits still outweigh the complications.

A Case of intractable epistaxis

The surgical management of intractable epistaxis by external carotid artery ligation may become complicated if there is a high bifurcation of the common carotid artery. Occlusion of the bleeding vessels by catheter embolization is described in a patient in whom exploration of the neck had failed to locate the external carotid artery.

Laser management of anterior epistaxis

Epistaxis is a common condition that often resolves with home remedies or with the attention of a primary care physician. However, 5% to 10% of patients suffer intractable epistaxis that requires the attention of an otolaryngologist. Among these cases, we may be faced with a patient who suffers recurrent epistaxis over a period of weeks to months that is associated with an anterior septal source. Conservative methods of packing and cauterization have failed and the patient suffers the annoyance, disability, and possible serious medical sequelae of significant blood loss. We introduce the results of a new surgical method for the management of intractable epistaxis from an anterior source. This technique abandons the laser ablation of septal vessels from outside the mucosa in favor of an approach from beneath the tissue surface. Standard septal surgical instruments are used to create familiar mucoperichondrial flaps where endoscopic visualization then permits Nd-YAG or argon laser obliteration of the septal vessels from beneath the mucosal surface.