Trans-radial embolization of epistaxis in patients with end-stage liver disease.
BACKGROUND
Endovascular treatment of epistaxis in patients with bleeding disorders is challenging due to the intrinsic risk of hemorrhagic complication related to the arterial access. We describe the use of trans-radial approach for the endovascular embolization of epistaxis due to end-stage liver disease and resultant severe coagulopathy.


METHODS
Two patients waiting for liver transplant continued to have epistaxis despite the aggressive correction of the coagulopathy and nose packing. After performing the Allen's test, trans-radial embolization of the epistaxis was performed in both patients.


RESULTS
The complete cessation of epistaxis was achieved after the trans-radial embolization of bilateral maxillary arteries with particles. The radial access sites were manually compressed for 1 h, followed by a compression dressing for 12 h. The cessation of the epistaxis helped the subsequent treatment of correcting the coagulopathy. There was no complication related to the arterial puncture.


CONCLUSIONS
Trans-radial embolization for epistaxis was a safe and effective method for the patient with end-stage liver disease and resultant severe coagulopathy.
Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, University of California-Los Angeles, CA 90095-7437, USA. stateshima@mednet.ucla.edu
Satoshi
S
Tateshima
Michael
M
Froehler
Ryan
R
Cramer
Sachin
S
Rastogi
Fernando
F
Viñuela
D004621:Embolization, Therapeutic / Q000379:methods*; D058625:End Stage Liver Disease / Q000150:complications*; D004844:Epistaxis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D017534:Radial Artery