title: Selective endovascular embolization for refractory idiopathic epistaxis is a safe and effective therapeutic option: technique, complications, and outcomes.
abstract: Epistaxis generally responds to conservative management, but a more invasive approach, such as superselective embolization, is sometimes justified. We report our experience with endovascular procedures in 19 patients from 2002 to 2011 for the treatment of refractory idiopatic posterior epistaxis. The sphenopalatine artery and distal internal maxillary arteries were embolized in all patients. Unilateral embolization was performed in 12 patients (63%), bilateral embolization in seven (37%). Additional embolization of the descending palatine artery was performed in eight patients (42%) and embolization of the facial artery and palatine arteries in four (21%). In one patient the distal ophthalmic artery was embolized with n-butyl cyanoacrylate. No minor or major complications occurred in relation to the embolization procedures. The average hospital stay was 11.1±8.6 days, including an average 5.2±3.4 days after embolization. Average follow-up after discharge was 21.3±25.7 months. Superselective endovascular embolization proved safe and effective in controlling idiopathic epistaxis, refractory to other maneuvers.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. jcohenns@yahoo.com
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
authors.forename: Samuel
authors.initials: S
authors.lastname: Moscovici
authors.forename: John M
authors.initials: JM
authors.lastname: Gomori
authors.forename: Ron
authors.initials: R
authors.lastname: Eliashar
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Weinberger
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004844:Epistaxis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008438:Maxillary Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D009296:Nasal Cavity / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology*; D011859:Radiography; D012189:Retrospective Studies