title: Transarterial embolization for acute head and neck bleeding: eight-year experience with emphasis on rebleeding risk in cancer patients.
abstract: OBJECTIVE
  To present our 8-year experience with transarterial embolization for head and neck bleeding, with an emphasis on the need for repeated procedures in patients treated for head and neck cancer.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary university-affiliated medical center. The cohort included 49 patients who underwent transarterial embolization for acute head and neck bleeding in 2004 to 2012. Outcome measures included procedural success, recurrence, complications, and outcome.
  
  
  RESULTS
  Mean patient age was 60.3 years. Indications for transarterial embolization were bleeding from a tumor (42%), nasal bleeding (36%), bleeding related to neck trauma (8%), tracheal stomal bleeding (8%), and other (4%). Twelve of 21 patients with tumors had been treated by chemoradiation. At least one repeated procedure was required in 11 patients, of whom nine had a history of chemoradiation and surgery for cancer; four of them required a stent for exclusion of pseudoaneurysm, and in six the recurrence presented late after the initial procedure (1 month to 5 years). Major complications included cerebrovascular accident in one patient and death due to major bleeding in two cases. Twenty-one patients died during follow-up, including nine patients with cancer. Eleven deaths occurred up to 4 years after embolization.
  
  
  CONCLUSIONS
  Transarterial embolization is an important tool for the control of head and neck bleeding. Special attention should be given to patients after chemoradiation for cancer. Every effort should be made to control the bleeding because some patients may gain a reasonable lifespan and improved quality of life.
  
  
  METHODS
  4.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel. gidybahar@gmail.com
authors.forename: Gideon
authors.initials: G
authors.lastname: Bachar
authors.forename: Najjar
authors.initials: N
authors.lastname: Esmat
authors.forename: Sagit
authors.initials: S
authors.lastname: Stern
authors.forename: Sergey
authors.initials: S
authors.lastname: Litvin
authors.forename: Michael
authors.initials: M
authors.lastname: Knizhnik
authors.forename: Eliyahu
authors.initials: E
authors.lastname: Perlow
authors.forename: Eli
authors.initials: E
authors.lastname: Atar
authors.forename: Thomas
authors.initials: T
authors.lastname: Shpitzer
authors.forename: Alexander
authors.initials: A
authors.lastname: Belenky
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000098:blood supply / Q000150:complications*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult