Successful Control Of Bleeding Research Articles

Validating the CHAMPS Score: A Novel and Reliable Prognostic Score of Non-Variceal Upper Gastrointestinal Bleeding.

The Charlson Comorbidity Index ≥2, in-Hospital onset, Albumin <2.5 g/dL, altered Mental status, Eastern Cooperative Oncology Group Performance status ≥2, Steroid use (CHAMPS) score is a novel and promising prognostic tool. We present an initial external validation of the CHAMPS score for predicting mortality in acute nonvariceal upper gastrointestinal bleeding (NVUGIB) across multiple clinical outcomes. A prospective cohort study was conducted on adult patients with NVUGIB admitted to the Department of Gastroenterology between November 2022 and June 2023. The CHAMPS score performance in predicting in-hospital outcomes was evaluated by employing area under the receiver operating characteristic (AUROC) curves, followed by a comparative analysis with five pre-existing scores. A total of 140 patients were included in the study. The CHAMPS score showed its highest performance in predicting mortality rates (AUROC = 0.89), significantly outperforming the Glasgow-Blatchford Bleeding Score (GBS) as well as the Albumin level <3.0 mg/dL, International normalized ratio >1.5, altered Mental status, Systolic blood pressure ≤90 mmHg, and age >65 years (AIMS65) score (AUROC = 0.72 and 0.71, respectively; all p < 0.05). Subgroup analysis for bleeding-related and non-bleeding-related mortality further confirmed the robust predictive capability of the CHAMPS score (AUROC = 0.88 and 0.87, respectively). The CHAMPS score failed to predict rebleeding and intervention reliably, exhibiting AUROC values of 0.43 and 0.55, respectively. The optimal CHAMPS score cutoff value for predicting mortality was 3 points, achieving 100% sensitivity and 71.2% specificity. In the low-risk category defined by both CHAMPS and GBS scores, mortality and rebleeding rates were 0%. However, within the CHAMPS score-based low-risk group, 58.8% required intervention, contrasting with a 0% intervention rate for the GBS score-based low-risk group (GBS score ≤1). The CHAMPS score consistently demonstrated a robust predictive performance for mortality (AUROC > 0.8), facilitating the identification of high-risk patients requiring aggressive treatment and low-risk patients in need of localized treatment or safe discharge after successful bleeding control.

Comparison of 2 Days versus 5 Days of Octreotide after Endoscopic Therapy in Preventing Early Esophageal Varices Rebleed: A Randomized Controlled Study

In esophageal varices bleeding, following the initial endoscopic hemostasis, it is recommended to administer vasoactive medications for a period of 2-5 days in order to avoid early rebleeding. Octreotide is the preferred vasoactive medication for treating variceal bleeding due to its favorable safety profile. This study aimed to assess the effectiveness of a 2-day octreotide infusion against a 5-day octreotide infusion following endoscopic intervention in avoiding early rebleeding of esophageal varices in individuals with cirrhosis. This study was a prospective, parallel, randomised controlled experiment conducted on a cohort of 184 subjects who were recruited from the endoscopy unit of the Tropical Medicine and Infectious Diseases Department at Tanta University Hospital in Egypt. The five days rate of rebleeding was 16.85% in the 2-days group against 15.91% in the 5- days group without significant difference (P= 0.865). In cirrhotic individuals with bleeding esophageal varices, a 2-day regimen of octreotide is equally efficacious as a 5-day regimen in avoiding rebleeding over a 5-day period, following successful control of bleeding with endoscopic intervention.

IBC-Oxford University2023_BJSOral_19Prospective Non-Randomized Study comparing the outcomes of Single Anastomosis Sleeve Jejunal Bypass (SASJ) with One Anastomosis Gastric Bypass (OAGB)

Abstract Background Single anastomosis Sleeve Jejunal Bypass (SASJ) is a relatively new bariatric/metabolic procedure. It is the single anastomosis modification of the Sleeve Gastrectomy with Bipartition operation developed by Santoro in 2012. Few studies have been published on its efficacy and safety, and fewer studies have been performed comparing its outcome with recognized bariatric procedures. Patients and Methods This is a prospective nonrandomized comparative study. Eighty patients were included in the study, 40 patients underwent SASJ and 40 underwent OAGB, in Ain Shams University Hospitals over 12 months between June 2021 and June 2022. Patients were followed up for at least one year. Both groups are compared for operative time, complications, costs, postoperative weight loss, resolution of co-morbidities, and complications. Results The one year follow up was completed by 34 patients in the SASJ group, and 38 patients in the OAGB group. The difference in operative time was not statistically significant. Intraoperative bleeding occurred in 3 cases in the OAGB group, one was successfully managed by conservative management and 2 required re-laparoscopy for successful control of bleeding. No leakage occurred in both groups. There was no statistically significant difference in EWL%, as it was 68.6 % ± 7.2 one year after SASJ and 71.3 % ± 5.7 % after OAGB. TWL% was 35.9 % ± 4.2 one year after SASJ and 36.2 % ± 3.8 % after OAGB, with no statistical difference. T2 DM resolution took place in 100% of patients after both procedures. However, bile reflux was higher after SASJ (17.6%, 6/34 patients), as compared to OAGB (13.2 %, 5/38 patients), yet statistically, the difference was not significant. Conclusion SASJ is an effective and safe bariatric/metabolic operation. Its outcome is comparable to that of OAGB. It deserves further study.

ACQUIRED VON WILLEBRAND SYNDROME SECONDARY TO MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE: LONG-TERM REMISSION AFTER TREATMENT WITH BORTEZOMIB

To describe a case report of a patient with monoclonal gammopathy of undetermined significance (MGUS) who progressed to Acquired von Willebrand syndrome (AVWS) and was successfully treated with bortezomib. Case report with literature review. A 54-years-old woman presented at our center to investigate an M-spike. She had been treated for chronic kidney disease due to glomerulonephritis for eight years and was on peritoneal dialysis waiting for a kidney transplant. During laboratory workup, a serum M-protein (0.3 g/dL) was detected by protein electrophoresis and a monoclonal IgG kappa was identified. After one year of follow-up, and with stable M-protein levels, the patient started complaining of increased bleeding from minor wounds, bruises in inferior limbs and repeated episodes of epistaxis. The patient had no personal or family history of bleeding disorders. Laboratory testing included normal blood and platelet counts, normal prothrombin and thrombin time but increased activated partial thromboplastin time (APTT ratio 1.62). Mixing study results showed APTT correction. Factor VIII coagulant activity (FVIII:C) was 12% but no inhibitor was detected. Von Willebrand factor antigen (vWF:Ag) was 10% and ristocetin cofactor activity (vWF:RCo) was 3%, with a vWF:RCo/vWF:Ag ratio of 0.3. Given the absence of previous personal and family history of bleeding and the diagnosis of MGUS, the diagnostic hypothesis of AWVS was made. To confirm this hypothesis, we performed a recovery test after infusion of von Willebrand factor (vWF 50 UI/kg), which results were suggestive of increased vWF clearance. The patient required treatment only after three years of AVWS diagnosis due to severe lingual hematoma. She was treated with two units of packed red blood and immunoglobulin (0.4g per kg for five days), with successful bleeding control. vWF:Ag, vWF:RCo and FVIII:C levels were also increased but returned to baseline values after three weeks. Because the patient was scheduled to undergo a kidney transplantation and the high risk of bleeding could lead to graft loss, it was decided to treat the MGUS-associated AVWS. She was treated with three cycles of dexamethasone 20 mg and cyclophosphamide 300 mg with no response. A second line treatment was started with dexamethasone 12 mg and bortezomib 1.5mg/m2 for a total of five cycles. After the end of the treatment, APTT, vWF:Ag, vWF:RCo results normalized and monoclonal paraprotein was eradicated. The patient was submitted to a kidney transplantation without bleeding complications. Two years after the end of the treatment, she remains in remission, with undetectable monoclonal paraprotein and normal coagulation and VWF tests. MGUS-associated AWVS is a rare bleeding disorder, and few data is available on the best treatment approach. We reported a case that transiently responded to immunoglobulin. This response, however, was not sufficient to warrant hemostatic levels of vWF required for kidney transplantation. Treatment of MGUS with bortezomib and dexamethasone led to eradication of the M-spike and normalization of the coagulation parameters. This response was durable, as the patient remains in remission of both MGUS and AWVS two years after the end of the treatment. This particular case highlights the importance of treating the underlying cause of the coagulopathy once the remission of AVWS only occurred after monoclonal gammopathy was controlled.

Bleeding management in the operating theatre

Despite all the measures taken preoperatively, bleeding may persist and require surgical control. Before considering treatment, it is necessary to establish the diagnosis with the origin of the bleeding. Thesurgical procedure depends on the aetiology. There are many surgical options and adjuvant measures to consider. They should be known by the operating theatre nurse, who is amajor player in surgical management. Successful control of bleeding requires quality multidisciplinary collaboration.

Tension-Free Anterior Rerouting of the Facial Nerve in Management of Jugular Foramen Paragangliomas.

Tension-Free Anterior Rerouting of the Facial Nerve in Management of Jugular Foramen Paragangliomas.

Successful Damage Control Resuscitation with Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

1918 A Case of Recurrent Pneumatosis Intestinalis and Portal Venous Gas

INTRODUCTION: Mesenteric ischemia (MI) is caused by inadequate blood flow through the mesenteric vessels resulting in ischemic bowel. The most serious cases cause gangrenous bowel, leading to pneumatosis intestinalis (PI) and portal venous gas (PVG), often an ominous sign. CASE DESCRIPTION/METHODS: This is a case of a 63-year-old male who presented to the hospital with hematemesis and severe anemia. After massive transfusion, an EGD revealed actively bleeding gastric ulcers, requiring serial EGDs for successful control of bleeding. A CT revealed gastric distention with thickening of the duodenum and bilateral femoral vein opacities, later confirmed as deep vein thromboses. An IVC filter was subsequently placed, as he was not a candidate for anticoagulation. The patient was subsequently discharged on oral pantoprazole. Of note, there was no history of NSAID use or evidence of H. pylori. Repeat EGD 2 months later noted mild gastritis, but no ulcers were seen. A screening colonoscopy at the time noted only diverticulosis. He was continued on pantoprazole. 3 months later he presented to the hospital with acute onset nausea, vomiting, and diarrhea. A CT revealed PI at the gastric fundus, as well as PVG. An infectious work-up was negative, lactate was normal, and his symptoms resolved quickly. A subsequent repeat CT noted resolution of the PVG and reduction in PI. He represented to the hospital 1 month later again with nausea, vomiting, and diarrhea. A CT noted small bowel dilatation with air fluid levels, PI at the esophagus, stomach, and jejunum, and significant PVG. The initial lactate level was mildly elevated and his symptoms resolved quickly after bowel decompression. A subsequent CTA noted a significant reduction in PVG without evidence of vascular occlusion. A follow up EGD showed diffuse subepithelial hemorrhages without any evidence of recurrent ulcers. A subsequent CTE noted a thrombus above the IVC filter and an evolving hepatic infarction. He was asymptomatic at the time, however, he was admitted to the hospital for anticoagulation. He has since remained on warfarin without any recurrence of symptoms, PI, or PVG. A follow-up CTA showed a full resolution of venous thromboses. DISCUSSION: Previous case reports have described the development of PI and PVG secondary to underlying MI. This case highlights an example of MI secondary to an increase in the resistance of mesenteric blood flow due to venous thromboses. When investigating IP and PVG, underlying venous thromboses should always be considered.

Temporary Renal Artery Clamping With Hemostatic Materials in Diffuse Type of Spontaneous Renal Allograft Rupture: A Case Report

BackgroundSeveral surgical strategies have been introduced for spontaneous kidney rupture. Herein, we report on a case in which temporary artery clamping with hemostatic materials was performed. Case PresentationA 52-year-old man underwent renal transplant from a living donor (his 20-year-old son). Spontaneous allograft rupture occurred 6 days after transplant. He developed severe abdominal pain, hypotension, and mental changes. His blood hemoglobin level was 3.6 g/dL, which was indicative of severe hemorrhage. Immediate re-exploration revealed a large hematoma in the iliac fossa and that the renal allograft had ruptured, with multiple fracture lines on the entire surface. Because of diffuse surface rupture, surgical suture was not attempted. For manual compressive hemostasis, temporary artery clamping with hemostatic materials was performed. First, we identified the graft artery for temporary clamping, similar to the method in partial nephrectomy. Second, at the time of temporary clamping, the hemostatic matrix was sprayed on the surface of the renal graft. Third, we compressed the whole renal parenchyma with both hands and a dry pad for 5 minutes. After removing the clamp, successful bleeding control was confirmed. Finally, the graft was wrapped with oxidized cellulose. Renal biopsy in the operating room revealed the cause of rupture as acute rejection type IIB. ConclusionSpontaneous renal allograft rupture is a rare but serious complication. When surgical suture is not appropriate for the repair of the ruptured allograft, temporary artery clamping with hemostatic materials can be considered an alternative.

Postoperative hemorrhage caused by lumbar artery injury in corrective osteotomy for degenerative lumbar scoliosis: case report

The present study reported the case of a patient with degenerative lumbar scoliosis who suffered from postoperative hemorrhage due to lumbar artery injury in corrective osteotomy. The patient presented with decline of blood pressure, extremely low hemoglobin, even after blood transfusion and fluid infusion. Digital subtraction angiography showed lumbar artery injury. Successful control of bleeding and gradually stable vital signs were observed after vascular embolisation. Severe and complex spinal deformity, severe osteophytes in the anterior edge of vertebral body, hypertension, and angiosclerosis were the risk factors of large vascular injuries in spinal osteotomy. Lumbar artery injury should be highly suspected when unknown and progressively aggravating abdominal or back pain, abdominal distention, neurological symptoms of lower limbs, decline of blood pressure, increase of heart rate, decrease of hemoglobin level, continuously bloody drainage or incision bleeding occurred. Vascular embolisation was effective and safe in the management of iatrogenic lumbar artery injury.

Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience.

Background and study aims Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown. Patients and methods This is an international case series of patients who underwent endoscopic suturing for bleeding PUD. Primary outcome was rate of immediate hemostasis and rate of early rebleeding (within 72 hours). Secondary outcomes included technical success, delayed rebleeding (> 72 hours), and rate of adverse events (AEs). Results Ten patients (mean age 66.7 years, 30 % female) were included in this study. Nine (90 %) had prior failed endoscopy hemostasis with an average of 1.4 ± 0.7 (range 1 – 3) prior endoscopic sessions. Forrest classification was Ib in 5 (50 %), IIa in 3 (30 %), IIb in 1(10 %), and IIc in 1 (10 %). Mean suturing time was 13.4 ± 5.6 (range 3.5 to 20) minutes. Technical success was 100 %. Rate of immediate hemostasis was 100 % and rate of early rebleeding was 0 %. Mean number of sutures was 1.5 (range, 1 – 4). No AEs were observed. Delayed recurrent bleeding was not observed in any cases after a median of 11 months (range 2 – 56), after endoscopic suturing. Conclusions Oversewing of a bleeding or high-risk ulcer using endoscopic suturing appears to be a safe and effective method for achieving endoscopic hemostasis. It may be considered as rescue endoscopic therapy when primary endoscopic hemostasis fails to control the bleeding or when hemorrhage recurs after successful control of bleeding.

New method of stopping bleeding from the presacral venous plexus during the rectal cancer operation: a case report

Presacral venous bleeding is a rare but potentially fatal complication in pelvic surgery. This type of bleeding is difficult to control. Existing methods are not without shortcomings, therefore, the search for a more reliable method. We are present a case of successful bleeding control using by plates of medium-porous nitinol (pore size of 300–450 μm, permeability of 12 × 10–9). Hemostasis was carried out by pressing a plate to the bleeding zone for 4 minutes.

Acquired Deficiency of Von Willebrand Factor (wWF) Associated with Intestinal Angiodysplasia

Acquired von Willebrand's Disease (AVWD) is a rare bleeding disorder that has been associated with angiodysplasia. We present a 79-year-old gentleman that presented with gradually progressive generalized weakness and easy fatigability with history of recurrent self-limiting epistaxis. He is known to have chronic lymphocytic leukemia (CLL), multiple myeloma and acquired Von Willebrand factor deficiency (Ristocetin cofactor of 25%) for which he received multiple chemotherapy cycles, last was two weeks before admission. Examination was evident of pallor with no signs of active epistaxis. Labs showed Hb of 4.8 g/dl, WBC of 8,400 and Platelets of 150,000. Ferritin was 4.64. He received 3 packed RBC's with improvement of his hemoglobin to 9.1 g/dl. Given inactive bleeding he was discharged for outpatient upper and lower endoscopy. Two weeks later he presented with same complain and was found to have Hb of 6.4. He denies any further epistaxis, neither hematemesis, melena or hematochezia. Colonoscopy was done showing diffuse diverticulosis and hyperplastic polyp. Enteroscopy was done showing bleeding angioectasia in the second portion of the duodenum. The bleeding site was coagulated multiple times using a heater probe set at 20J and resulted in cessation of the bleeding. Given the multiple coagulations further advancement of the enteroscope was deferred. Video capsule endoscopy was done with no further small bowel lesions. Hb stayed stable overnight and he was discharged with close clinic follow up Acquired von Willebrand syndrome (AVWS) is a rare and probably underestimated bleeding disorder which mimics most of the clinical symptoms and laboratory features of hereditary von Willebrand disease (VWD) in patients devoid of both personal and family history of bleeding diathesis. The diagnosis and treatment of recurrent GI bleeding in acquired VWD remains challenging and is associated with significant morbidity.1955_A Figure 1. Bleeding angiodysplasia in the second part of the duodenum1955_B Figure 2. Bleeding angiodysplasia in the second part of the duodenum1955_C Figure 3. Successful control of bleeding with coagulation using a heater probe

O16-3 - A Case of Intractable Ventricular Fibrillation after Acute Myocardial Infarction Successfully Treated with Central Extracorporeal Membrane Oxygenation

The patient was a 42-year-old man with acute anteroseptal myocardial infarction which was treated with percutaneous coronary intervention at the other hospital. On the 9th hospital day, he suffered from intractable ventricular fibrillation; an extracorporeal mambrane oxygenation (ECMO) was inserted from the femoral. The patient was then transferred to our hospital. He was treated with catecholamines, water-loading, transfusion and continuous renal replacement therapy for cardiac shock and acute kidney injury, although, progressive anemia and expanding retroperitoneal hematoma remained. The results of computed tomography and internal pressure of the bladder suggested that he should have abdominal compartment syndrome. The ECMO was replaced from the femoral to central cannulation, which led to successful bleeding control, and removed one week later. The patient was treated with medications and rehabilitation therapy. Two months later, his renal function was improved; the patient was discharged on the 105th hospital day. Here, we report the suggestive case with some literature reviews.

Can Endoscopic Bleeding Control Improve the Prognosis of Advanced Gastric Cancer Patients?: A Retrospective Case-Control Study.

Gastric bleeding is not rare and difficult to treat in gastric cancer patients. We investigated whether this affects survival and if successful bleeding control improves the prognosis. We retrospectively reviewed medical records for 64 subjects who underwent endoscopic therapy for gastric cancer bleeding at Asan Medical Center from January 2012 to December 2014 (bleeding group). Each subject was matched 1:2 by age, sex, and American Joint Committee on Cancer staging with 128 randomly selected patients treated for stomach cancer during the same period (control group). Median survival, bleeding treatment methods, successful bleeding control, and rebleeding rate were investigated. The median age was 58.5 years, the male to female ratio 4.3:1. The initial hemostasis rate was 73.4%. Most patients were treated with a single method (37 patients, 57.8%); the coagrasper (32/95 cases, 33.7%) was the most frequently used treatment. Among the 47 patients in which successful bleeding control was achieved, 17 (36.2%) experienced rebleeding after 3 days. The median survival was longer in the control than in the bleeding group (18.5 vs. 6.5 mo), and in the successful bleeding control than in the failed bleeding control group (8.5 vs. 1.8 mo). However, the successful bleeding control group had lower survival than the control group (18.5 vs. 8.5 mo). Multivariate analysis showed that the risk of bleeding was lower in Borrmann type II, IV cancer, but was higher in the patients using antiplatelet or anticoagulant. Successful bleeding control is essential for improving survival in bleeding gastric cancer patients.

Segmental colectomy for bleeding diverticular disease guided by the PEEP test.

Many patients with massive lower gastrointestinal (GI) haemorrhage from diverticulosis are subjected to total colectomy when preoperative localisation is unavailable. We dissected colectomy specimens and noted that there was limited retrograde reflux in most of these cases. Therefore, we sought to assess the value of a positive endoluminal erythrocyte presence (PEEP) test (presence of fresh blood in the caecum) to direct segmental colectomies in 14 patients who required emergency operations for massive lower GI haemorrhage. Overall, 13 (93%) patients who had segmental colectomy guided by the PEEP test had successful control of bleeding. There was no mortality and a 14% postoperative morbidity after segmental resections guided by the PEEP test. One patient had persistent bleeding and required a completion colectomy on the third postoperative day. We propose that the PEEP test be added to the surgical armamentarium to guide segmental resection in the absence of localisation by conventional means. However, we advocate blind total colectomy if the PEEP test is equivocal and early completion colectomy if there is significant re-bleeding.

Endovascular Treatment for Carotid Blowout Syndrome after Radiation: A Case Report

Carotid blowout syndrome is one of the most complex bleeding complications that may occur in head and neck cancers patients. The purpose of this paper is to report the clinical manifestations and endovascular management of a case of patient with neck malignancies and a history of radiotherapy. The patient underwent immediate covered stent deployment which resulted in the successful control of bleeding.

Successful Control of Massive Bleeding in a Child with Burkitt's Lymphoma via a Biosimilar Recombinant Activated Factor VII (AryoSeven™).

We describe a case of a 4-year-old girl with Burkitt's lymphoma, who suffered from a massive gastrointestinal hemorrhage 3 days after chemotherapy. In spite of applying the common practice in correction of coagulopathy, thrombocytopenia persisted and bleeding became life-threatening. In the present case report, we report a successful control of bleeding with a single-dose administration of a biosimilar recombinant activated human factor VII (AryoSeven).

Use of Advanced Bleeding Control Mechanisms in Athletic Training: A Shift in the Thought Process of Prehospital Care—Part 1: Tourniquets

Two other competencies(Table 1), although not necessarily new to the list ofimmediate emergency management care skills, do requirefurther examination based on the current available scienceand standard of care in prehospital medicine. The purposeof this column is to provide athletic training educators(ATE) with evidence regarding the use of tourniquets in theprehospital setting as well as to be a resource on how toteach the management of external hemorrhage usingtourniquets.Trauma resulting in disruption of soft tissue is classified asan open or closed wound, and any significant loss ofintravascular volume may lead sequentially to hemodynam-ic instability, decreased tissue perfusion, cellular hypoxia,organ damage, and death.

Management of pseudoaneurysms of the internal carotid artery in postirradiated nasopharyngeal carcinoma patients

Massive epistaxis due to ruptured pseudoaneurysm of the internal carotid artery (ICA) is an often fatal complication of radiation treatment for patients with nasopharyngeal carcinoma. We review the clinical characteristics and predictors of survival in patients suffering from this serious complication after radiotherapy. Retrospective case series. Clinical records and radiological investigations of postirradiated NPC patients with ICA pseudoaneurysm diagnosed with digital subtraction angiography in Queen Mary Hospital from January 2003 to December 2012 were reviewed. Risk factors analyzed for survival included gender, size of initial tumor, history of second course of radiotherapy, history of previous maxillary swing nasopharyngectomy, presence of persistent disease, successful initial hemostasis, successful airway control, and endovascular treatment. Twenty-six were included in the analysis. Twenty-three patients underwent endovascular treatment, and 20 (87%) had successful control of the bleeding. Eighteen (69%) patients survived. Univariate analysis showed that successful temporary control of bleeding and airway control were associated with survival. Prompt bleeding control and airway management is necessary to improve survival. Endovascular treatment is a good definitive treatment option with a high success rate.