title: Facial necrosis after endovascular Onyx-18 embolization for epistaxis.
abstract: BACKGROUND
  Evolution in techniques and equipment has expanded the role, effectiveness, and safety of endovascular transarterial embolization for the treatment of severe epistaxis. Risks from this treatment approach include major ischemic complications. To date, there have been only a few reports of soft tissue necrosis following endovascular embolization for severe epistaxis; none involve the use of Onyx-18.
  
  
  METHODS
  We report the case of a 52-year-old woman who presented with epistaxis that was refractory to medical and surgical management, which lead to endovascular intervention and embolization with Onyx-18. The patient subsequently developed nasal ala and facial necrosis as a result of the procedure.
  
  
  CONCLUSIONS
  We report the use of Onyx-18 for the endovascular embolization of a patient with severe epistaxis and subsequent complications. In cases of severe epistaxis that warrant intervention in the form of embolization, ischemic complications are rare; however, ischemic complications may be unavoidable and should factor into the discussion regarding procedural risks.
authors: Department of Neurological Surgery, University of Pittsburgh Medical Center 200 Lothrop Street, 15207, Pittsburgh, PA, USA.
authors: Ramesh
authors: R
authors: Grandhi
authors: David
authors: D
authors: Panczykowski
authors: Nathan T
authors: NT
authors: Zwagerman
authors: Robin
authors: R
authors: Gehris
authors: Jennifer
authors: J
authors: Villasenor-Park
authors: Jonhan
authors: J
authors: Ho
authors: Lisa
authors: L
authors: Grandinetti
authors: Michael
authors: M
authors: Horowitz
keywords: Endovascular embolization; Onyx; epistaxis; soft tissue necrosis
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