Download PDF
Semin intervent Radiol 2020; 37(02): 150-156
DOI: 10.1055/s-0040-1709156
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Endovascular Treatment of Epistaxis

Joan C. Wojak
1   Department of Radiology, Our Lady of Lourdes Regional Medical Center, Lafayette, Louisiana
2   Department of Radiology, Louisiana State University School of Medicine, New Orleans, Louisiana
› Author Affiliations
Further Information

Publication History

Publication Date:
14 May 2020 (online)

Also available at
    Permissions and Reprints

Abstract

Epistaxis is not uncommon, with up to 60% of the population suffering from at least one episode in their lifetime and as many as 6% presenting for medical attention. An analysis of emergency room (ER) visits in the United States between 2009 and 2011 identified 1.2 million encounters for epistaxis, accounting for 0.32% of ER visits. Approximately 6% of patients will require more aggressive, invasive management in the form of transnasal ligation of the sphenopalatine artery or endovascular embolization. This article reviews the epidemiology, rationale for endovascular treatment, strategy for treatment, endovascular technique, postprocedural follow-up, and complications and their management.

Keywords

interventional radiology - epistaxis - embolization - endovascular treatment - complications
 

  • References

  • 1 Verillaud B, Robard L, Michel J. , et al; SFORL Work-Group. Guidelines of the French Society of Otorhinolaryngology (SFORL). Second-line treatment of epistaxis in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134 (03) 191-193
    CrossrefPubMedGoogle Scholar
  • 2 Sethi RKV, Kozin ED, Abt NB, Bergmark R, Gray ST. Treatment disparities in the management of epistaxis in United States emergency departments. Laryngoscope 2018; 128 (02) 356-362
    CrossrefPubMedGoogle Scholar
  • 3 Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo Jr CA. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med 2005; 46 (01) 77-81
    PubMedGoogle Scholar
  • 4 Cooper SE, Ramakrishnan VR. Direct cauterization of the nasal septal artery for epistaxis. Laryngoscope 2012; 122 (04) 738-740
    CrossrefPubMedGoogle Scholar
  • 5 Shay S, Shapiro NL, Bhattacharyya N. Epidemiological characteristics of pediatric epistaxis presenting to the emergency department. Int J Pediatr Otorhinolaryngol 2017; 103: 121-124
    CrossrefPubMedGoogle Scholar
  • 6 Sylvester MJ, Chung SY, Guinand LA, Govindan A, Baredes S, Eloy JA. Arterial ligation versus embolization in epistaxis management: counterintuitive national trends. Laryngoscope 2017; 127 (05) 1017-1020
    CrossrefPubMedGoogle Scholar
  • 7 Robinson AE, McAuliffe W, Phillips TJ, Phatouros CC, Singh TP. Embolization for the treatment of intractable epistaxis: 12 month outcomes in a two centre case series. Br J Radiol 2017; 90 (1080): 20170472
    CrossrefPubMedGoogle Scholar
  • 8 Reyre A, Michel J, Santini L. , et al. Epistaxis: the role of arterial embolization. Diagn Interv Imaging 2015; 96 (7-8): 757-773
    CrossrefPubMedGoogle Scholar
  • 9 Marin E, Watelet JB, Gevaert P, Van Zele T. Severe spontaneous epistaxis: retrospective study in a tertiary ENT centre. Eur Arch Otorhinolaryngol 2019; 276 (06) 1693-1699
    CrossrefPubMedGoogle Scholar
  • 10 Peterson J. Hereditary hemorrhagic telangiectasia management. Radiol Technol 2017; 88 (03) 277-294
    PubMedGoogle Scholar
  • 11 Robard L, Michel J, Prulière Escabasse V. , et al; SFORL Work-Group. Guidelines of the French Society of Otorhinolaryngology (SFORL) (short version). Specific treatment of epistaxis in Rendu-Osler-Weber disease. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134 (01) 37-41
    CrossrefPubMedGoogle Scholar
  • 12 Makhasana JAS, Kulkarni MA, Vaze S, Shroff AS. Juvenile nasopharyngeal angiofibroma. J Oral Maxillofac Pathol 2016; 20 (02) 330
    PubMedGoogle Scholar
  • 13 Dong F, Li Q, Wu J. , et al. Carotid blowout syndrome after nasopharyngeal carcinoma radiotherapy: successful treatment by internal carotid artery occlusion after stent implantation failure. Springerplus 2016; 5 (01) 1553
    CrossrefPubMedGoogle Scholar
  • 14 Mak CH, Cheng KM, Cheung YL, Chan CM. Endovascular treatment of ruptured internal carotid artery pseudoaneurysms after irradiation for nasopharyngeal carcinoma patients. Hong Kong Med J 2013; 19 (03) 229-236
    PubMedGoogle Scholar
  • 15 Grandhi R, Brasiliense LBC, Williamson R, Zwagerman NT, Sauvageau E, Hanel RA. Delayed Pipeline embolization of a ruptured true internal carotid artery aneurysm presenting with epistaxis: case report and review of the literature. World Neurosurg 2019; 125: 273-276
    CrossrefPubMedGoogle Scholar
  • 16 Raper DM, Ding D, Peterson EC. , et al. Cavernous carotid aneurysms: a new treatment paradigm in the era of flow diversion. Expert Rev Neurother 2017; 17 (02) 155-163
    CrossrefPubMedGoogle Scholar
  • 17 Ozono Y, Nishiike S, Ishihara M, Fujinaka T. Rupture of Internal carotid artery pseudoaneurysm in the sphenoid sinus as a complication of deep neck space infection. J Med Invest 2019; 66 (1.2): 188-189
    CrossrefPubMedGoogle Scholar
  • 18 Ko JK, Lee SW, Lee TH, Choi CH. Traumatic carotid cavernous fistula with a connection between the supraclinoid internal carotid artery and cavernous sinus via a pseudoaneurysm presenting with delayed life-threatening epistaxis. NMC Case Rep J 2017; 4 (02) 43-46
    PubMedGoogle Scholar
  • 19 Liu QL, Xue H, Qi CJ, Zhao P, Wang DH, Li G. Traumatic anterior cerebral artery pseudoaneurysmal epistaxis. World Neurosurg 2017; 100: 713.e9-713.e16
    CrossrefPubMedGoogle Scholar
  • 20 De Los Reyes KM, Gross BA, Frerichs KU. , et al. Incidence, risk factors and management of severe post-transsphenoidal epistaxis. J Clin Neurosci 2015; 22 (01) 116-122
    CrossrefPubMedGoogle Scholar
  • 21 Goljo E, Dang R, Iloreta AM, Govindaraj S. Cost of management in epistaxis admission: Impact of patient and hospital characteristics. Laryngoscope 2015; 125 (12) 2642-2647
    CrossrefPubMedGoogle Scholar
  • 22 Brinjikji W, Kallmes DF, Cloft HJ. Trends in epistaxis embolization in the United States: a study of the Nationwide Inpatient Sample 2003-2010. J Vasc Interv Radiol 2013; 24 (07) 969-973
    CrossrefPubMedGoogle Scholar
  • 23 Rudmik L, Leung R. Cost-effectiveness analysis of endoscopic sphenopalatine artery ligation vs arterial embolization for intractable epistaxis. JAMA Otolaryngol Head Neck Surg 2014; 140 (09) 802-808
    CrossrefPubMedGoogle Scholar
  • 24 Villwock JA, Jones K. Recent trends in epistaxis management in the United States: 2008-2010. JAMA Otolaryngol Head Neck Surg 2013; 139 (12) 1279-1284
    PubMedGoogle Scholar
  • 25 de Bonnecaze G, Gallois Y, Bonneville F, Vergez S, Chaput B, Serrano E. Transnasal endoscopic sphenopalatine artery ligation compared with embolization for intractable epistaxis: a long-term analysis. Am J Rhinol Allergy 2018; 32 (03) 188-193
    CrossrefPubMedGoogle Scholar
  • 26 Swords C, Patel A, Smith ME, Williams RJ, Kuhn I, Hopkins C. Surgical and interventional radiological management of adult epistaxis: systematic review. J Laryngol Otol 2017; 131 (12) 1108-1130
    CrossrefPubMedGoogle Scholar
  • 27 Dubel GJ, Ahn SH, Soares GM. Transcatheter embolization in the management of epistaxis. Semin Intervent Radiol 2013; 30 (03) 249-262
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Strach K, Schröck A, Wilhelm K. , et al. Endovascular treatment of epistaxis: indications, management, and outcome. Cardiovasc Intervent Radiol 2011; 34 (06) 1190-1198
    CrossrefPubMedGoogle Scholar
  • 29 Loon NW, Gendeh BS, Zakaria R, Hamzah JC, Din NM. Ophthalmic artery occlusion following neuro-embolization of the external carotid artery, a case report. BMC Ophthalmol 2017; 17 (01) 92
    CrossrefPubMedGoogle Scholar
  • 30 Nishimoto K, Minoda R, Yoshida R, Hirai T, Yumoto E. A case of periodontal necrosis following embolization of maxillary artery for epistaxis. Case Rep Otolaryngol 2016; 2016: 6467974
    PubMedGoogle Scholar
  • 31 Khoury NN, Champagne PO, Kotowski M, Raymond J, Roy D, Weill A. Unexpected complications with head and neck hydrogel microsphere particle embolization: a case series and a technical note. Interv Neuroradiol 2017; 23 (01) 107-111
    CrossrefPubMedGoogle Scholar
  • 32 Gillard M, Archier E, Monnet O. , et al. [Cutaneous foreign body granulomas following cervico-facial arterial embolization: Three cases]. Ann Dermatol Venereol 2018; 145 (11) 659-664
    CrossrefPubMedGoogle Scholar
  • 33 Seidel DU, Remmert S, Brassel F, Schlunz-Hendann M, Meila D. Superselective microcoil embolization in severe intractable epistaxis: an analysis of 12 consecutive cases from an otorhinolaryngologic and an interventional neuroradiologic point of view. Eur Arch Otorhinolaryngol 2015; 272 (11) 3317-3326
    CrossrefPubMedGoogle Scholar
  • 34 Hayes SB, Johnson JN, Most Z, Elhammady MS, Yavagal D, Aziz-Sultan MA. Transarterial embolization of intractable nasal and oropharyngeal hemorrhage using liquid embolic agents. J Neurointerv Surg 2015; 7 (07) 537-541
    CrossrefPubMedGoogle Scholar
  • 35 Al-Samkari H, Kritharis A, Rodriguez-Lopez JM, Kuter DJ. Systemic bevacizumab for the treatment of chronic bleeding in hereditary haemorrhagic telangiectasia. J Intern Med 2019; 285 (02) 223-231
    CrossrefPubMedGoogle Scholar
  • 36 Iyer VN, Apala DR, Pannu BS. , et al. Intravenous bevacizumab for refractory hereditary hemorrhagic telangectasia-related epistaxis and gastrointestinal bleeding. Mayo Clin Proc 2018; 93 (02) 155-166
    CrossrefPubMedGoogle Scholar
  • 37 Hsu YP, Hsu CW, Bai CH, Cheng SW, Chen C. Medical treatment for epistaxis in hereditary hemorrhagic telangectasia: a meta-analysis. Otolaryngol Head Neck Surg 2019; 160 (01) 22-35
    CrossrefPubMedGoogle Scholar
  • 38 Halderman AA, Ryan MW, Marple BF, Sindwani R, Reh DD, Poetker DM. Bevacizumab for epistaxis in hereditary hemorrhagic telangectasia: an evidence-based review. Am J Rhinol Allergy 2018; 32 (04) 258-268
    CrossrefPubMedGoogle Scholar
  • 39 Steineger J, Geirdal AO, Osnes T, Heimdal KR, Dheyauldeen S. Intranasal bevacizumab injections improve quality of life in HHT patients. Laryngoscope 2019; DOI: 10.1002/lary.28179. [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 40 Stokes P, Rimmer J. Intranasal bevacizumab in the treatment of HHT -related epistaxis: a systematic review. Rhinology 2018; 56 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 41 Riss D, Burian M, Wolf A, Kranebitter V, Kaider A, Arnoldner C. Intranasal submucosal bevacizumab for epistaxis in hereditary hemorrhagic telangiectasia: a double-blind, randomized, placebo-controlled trial. Head Neck 2015; 37 (06) 783-787
    CrossrefPubMedGoogle Scholar
  • 42 Wojak JC. Epistaxis. In: Prestigiacomo C. , ed. Surgical Endovascular Neuroradiology. New York: Thieme; 2015: 352-359
    Google Scholar
  • 43 Harwood AR, Wojak JC, Barry R. External beam radiotherapy for severe epistaxis from Osler-Weber-Rendu disease. J La State Med Soc 2002; 154 (03) 154-155
    PubMedGoogle Scholar
  • 44 McIntosh DL, Douglas G, Lee K, Allen J, Mahadevan M. External carotid artery blood supply to the orbit. Int J Pediatr Otorhinolaryngol 2007; 71 (10) 1623-1626
    CrossrefPubMedGoogle Scholar
  • 45 Koh E, Frazzini VI, Kagetsu NJ. Epistaxis: vascular anatomy, origins, and endovascular treatment. AJR Am J Roentgenol 2000; 174 (03) 845-851
    CrossrefPubMedGoogle Scholar
  • 46 Duncan IC, Dos Santos C. Accessory meningeal arterial supply to the posterior nasal cavity: another reason for failed endovascular treatment of epistaxis. Cardiovasc Intervent Radiol 2003; 26 (05) 488-491
    PubMedGoogle Scholar