title: Epistaxis in patients with hereditary hemorrhagic telangiectasia treated with selective arterial embolization.
abstract: BACKGROUND
  Hereditary hemorrhagic telangiectasia (HHT) is a rare systemic fibrovascular dysplasia also known as Rendu-Osler-Weber disease. Epistaxis is often the first and foremost symptom of the disease and recurrent epistaxis is the main complaint.
  
  
  OBJECTIVE
  Evaluation of effectiveness and safety of endovascular treatment of epistaxis in HHT patients.
  
  
  METHODS
  Between June 2004 and January 2008, 14 patients with HHT underwent embolization of external carotid artery (ECA) branches due to severe epistaxis. There were eight men and six women aged 27-42 years. Patients were referred for endovascular treatment when primary management with electrocautery and nasal packing was ineffective. Arteries suspected of bleeding were catheterized super-selectively with micro-catheters to perform embolization. Polyvinyl alcohol particles (PVA) or embospheres in diameter of 500-700-µm were used as an embolic material.
  
  
  RESULTS
  Embolization was technically successful in 11 (78.5%) patients. Immediate, complete control of bleeding was achieved in 12 (85%) patients. During long-term follow-up recurrent nasal bleeding occurred in six (43%) patients 6-24 months after treatment. There were no severe complications after embolization. Nine patients experienced mild facial pain which resolved within three days after the treatment. Three patients in whom arterial spasm was observed, suffered from facial paraesthesia lasting for 3-5 days after embolization. Out of 14 patients, 12 were available for 24-month follow-up evaluation. All except one claimed reduction in frequency and severity of epistaxis which had a positive impact on their quality of life.
  
  
  CONCLUSIONS
  Endovascular embolization of epistaxis in patients with HHT is an effective and safe procedure although it cannot provide a long-term cure in most cases. Embolization reduces the frequency, severity and duration of nasal bleeding in patients with HHT, improving patients' quality of life.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Medical University in Lublin, Poland. troja23@yahoo.com
authors.forename: Piotr
authors.initials: P
authors.lastname: Trojanowski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Jargiello
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Trojanowska
authors.forename: Janusz
authors.initials: J
authors.lastname: Klatka
mesh_terms: D000328:Adult; D000792:Angiography; D002342:Carotid Artery, External; D004621:Embolization, Therapeutic / Q000379:methods*; D004844:Epistaxis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008863:Microspheres; D011142:Polyvinyl Alcohol; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D011142:Polyvinyl Alcohol