title: Transarterial embolization of intractable nasal and oropharyngeal hemorrhage using liquid embolic agents.
abstract: BACKGROUND
  Intractable hemorrhage of the nasal or oropharyngeal cavities can be life threatening, and endovascular embolization is one of the few effective treatments for severe recurrent bleeds. Traditionally, embolic particles have been used for transarterial embolization.
  
  
  OBJECTIVE
  To investigate the safety and efficacy of a less commonly performed treatment-namely, feeding artery occlusion with liquid embolic agents.
  
  
  METHODS
  We retrospectively reviewed our neurointerventional database for patients who had undergone transarterial embolization for intractable nasal and oropharyngeal hemorrhage with Onyx, N-butyl-2 cyanoacrylate (n-BCA) glue, or both, at our institution over a 5-year period from 2008 to 2013.
  
  
  RESULTS
  Forty-six patients who underwent a total of 51 procedures met the inclusion criteria. Causes of hemorrhage included neoplasm n=35 (68.6%), trauma n=12 (23.5%), and idiopathic n=4 (7.9%). The bleeding was oropharyngeal in 66.7%, nasal in 29.4%, and 3.9% originated from both sites. Embolic agents used were n-BCA in 26 cases (51.0%), Onyx in 22 cases (43.1%), and both agents in three cases (5.9%). Mean total procedural time was 93.1 min (range 34-323 min), and mean fluoroscopy time was 39.1 min (10- 121 min). Mean follow-up time was 7.4 months (0.25-36 months). Five of the 46 patients (10.9%) required re-embolization and one (2.0%) rebled during the same hospital stay. One periprocedural cardiovascular adverse event occurred that was unrelated to the embolic agent used, but no other complications were seen.
  
  
  CONCLUSIONS
  Transarterial embolization with n-BCA or Onyx is a safe and effective treatment for patients with intractable nasal and oropharyngeal hemorrhage. Further prospective studies are warranted to confirm these findings.
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Seth B
authors.initials: SB
authors.lastname: Hayes
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Jeremiah N
authors.initials: JN
authors.lastname: Johnson
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Most
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Mohamed Samy
authors.initials: MS
authors.lastname: Elhammady
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida, USA Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Dileep
authors.initials: D
authors.lastname: Yavagal
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, Florida, USA Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage*; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage*; D004844:Epistaxis / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000000981:diagnostic imaging*; D011145:Polyvinyls / Q000008:administration & dosage*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004659:Enbucrilate; D004121:Dimethyl Sulfoxide
keywords: Hemorrhage; Liquid Embolic Material; Nasal cavity; Oral cavity; Tumor