title: Endovascular treatment of epistaxis: indications, management, and outcome.
abstract: OBJECTIVE
  Epistaxis is a common clinical problem, and the majority of bleedings can be managed conservatively. However, due to extensive and sometimes life-threatening bleeding, further treatment, such as superselective embolization, may be required. We report our experience with endovascular treatment of life-threatening epistaxis.
  
  
  METHODS
  All patients presenting with excessive epistaxis, which received endovascular treatment at a German tertiary care facility between January 2001 and December 2009, were retrospectively identified. Demographic data, etiology, origin and clinical relevance of bleeding, interventional approach, therapy-associated complications, and outcome were assessed.
  
  
  RESULTS
  A total of 48 patients required 53 embolizations. Depending on the etiology of bleeding, patients were assigned to three groups: 1) idiopathic epistaxis (31/48), 2) traumatic or iatrogenic epistaxis (12/48), and 3) hereditary hemorrhagic telangiectasia (HHT) (5/48). Eleven of 48 patients required blood transfusions, and 9 of these 11 patients (82%) were termed clinically unstable. The sphenopalatine artery was embolized unilaterally in 10 of 53 (18.9%) and bilaterally in 41 of 53 (77.4%) procedures. During the same procedure, additional vessels were embolized in three patients (3/53; 5.7%). In 2 of 53(3.8%) cases, the internal carotid artery (ICA) was occluded. Long-term success rates of embolization were 29 of 31 (93.5%) for group 1 and 11 of 12 (91.7%) for group 2 patients. Embolization of patients with HHT offered at least a temporary relief in three of five (60%) cases. Two major complications (necrosis of nasal tip and transient hemiparesis) occurred after embolization.
  
  
  CONCLUSIONS
  Endovascular treatment proves to be effective for prolonged and life-threatening epistaxis. It is easily repeatable if the first procedure is not successful and offers a good risk-benefit profile.
authors.affiliation: Division of Neuroradiology, Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Strach
authors.forename: Andreas
authors.initials: A
authors.lastname: Schröck
authors.forename: Kai
authors.initials: K
authors.lastname: Wilhelm
authors.forename: Susanne
authors.initials: S
authors.lastname: Greschus
authors.forename: Henriette
authors.initials: H
authors.lastname: Tschampa
authors.forename: Markus
authors.initials: M
authors.lastname: Möhlenbruch
authors.forename: Claas P
authors.initials: CP
authors.lastname: Naehle
authors.forename: Mark
authors.initials: M
authors.lastname: Jakob
authors.forename: Andreas O H
authors.initials: AO
authors.lastname: Gerstner
authors.forename: Friedrich
authors.initials: F
authors.lastname: Bootz
authors.forename: Hans H
authors.initials: HH
authors.lastname: Schild
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D004844:Epistaxis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome