Arterial embolization in the management of posterior epistaxis.
OBJECTIVE
Treatment of severe epistaxis can encompass many modalities. Control rates with all treatments are good. Morbidity among treatment groups varies. Angiographic embolization is one such method that has a very low complication rate. Over the last 10 years, it has become the preferred treatment at our institution.


METHODS
Tertiary medical referral centers: OHSU, Portland VAMC.


METHODS
Retrospective review of 70 patients transferred or admitted with posterior epistaxis and treated with selective angiographic embolization from 1993 to 2002.


RESULTS
Patients had bleeding for a median of 4.5 days prior to admission. 79% were unilateral. Etiology of bleeding was: idiopathic (61%), previous surgery (11%), anticoagulants (9%), trauma (7%), and other causes (12%). 30% required blood transfusions prior to admission to OHSU (average 4.4 units). No patient required a transfusion postoperatively following angiographic embolization or during their hospitalization. The internal maxillary artery (IMAX) was embolized in 94% (47% unilateral or bilateral IMAX only, 47% unilateral or bilateral IMAX in combination with other vessels, 6% other vessels besides the IMAX). Mean length of stay was 2.5 days. 86% had minor or no complications after the embolization and were discharged within 24 hours. 13% had a major rebleed that required surgical intervention within 6 weeks of the embolization. One patient had a serious neurological complication. Using the data available on 68 of 70 patients, the cost of hospitalization averaged dollar 18,000 with direct costs of embolization averaging dollar 11,000.


CONCLUSIONS
Angiographic embolization is a clinically effective treatment for severe epistaxis.


METHODS
C.
Christensen
Nathan P
NP
Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
Smith
Dana S
DS
Barnwell
Stanley L
SL
Wax
Mark K
MK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D002648:Child; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D004844:Epistaxis / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008438:Maxillary Artery; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome