Endovascular treatment of acute and subacute hemorrhage in the head and neck.
OBJECTIVE
Acute and subacute hemorrhage in the head and neck often represent a life-threatening situation. The goal of this study is to evaluate the indications for and contributions of endovascular techniques in the diagnosis and management of such severe cases.


METHODS
Seventy-two patients with acute or subacute intractable hemorrhage of the head and neck were treated over a period of 5 years: 2 patients had experienced trauma; in 6 cases the cause of bleeding was iatrogenic; and in 2 patients intraosseous arteriovenous malformations were manifested. Fifteen patients had tumors, 9 of whom had prior radiotherapy. Forty-seven patients presented with epistaxis (41 idiopathic and 6 during anticoagulation therapy). The endovascular therapy was performed using polyvinyl alcohol particles, fibered platinum or electrolytically detachable coils (Guglielmi detachable coils; Target Therapeutics, Fremont, Calif), a stent, glue (Ethibloc; Ethicon GmbH, Norderstedt, Germany, and Histoacryl; B. Braun Melsungen AG, Melsungen, Germany), or with a combination of these different embolic materials.


RESULTS
The acute bleeding was successfully controlled in all cases. Fourteen patients (7 with epistaxis, 5 with tumors, and 2 with arteriovenous malformations) had to be embolized more than once before the bleeding could be controlled. The idiopathic, traumatic, iatrogenic, and remaining tumoral cases were treated only once. The long-term morbidity was 1.9%.


CONCLUSIONS
Owing to the recent continuous advances in interventional radiologic techniques, it is possible to treat both acute and subacute life-threatening head and neck hemorrhage most efficiently. In many cases the endovascular therapy complements surgery.
Remonda
L
L
Division of Neuroradiology, University of Bern-Inselspital, Freiburgstrasse 10, CH-3010 Bern, Switzerland.
Schroth
G
G
Caversaccio
M
M
Lädrach
K
K
Lövblad
K O
KO
Zbären
P
P
Raveh
J
J
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001165:Arteriovenous Malformations / Q000628:therapy; D002648:Child; D006259:Craniocerebral Trauma / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D004844:Epistaxis / Q000628:therapy; D005260:Female; D006257:Head / Q000098:blood supply; D006258:Head and Neck Neoplasms / Q000150:complications; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged