title: Superselective microcoil embolization in severe intractable epistaxis: an analysis of 12 consecutive cases from an otorhinolaryngologic and an interventional neuroradiologic point of view.
abstract: From 2006 to 2013, 12 patients with severe epistaxis refractory to prior conservative and surgical therapy were treated by superselective embolization of nasal arteries. Supersoft platinum microcoils with smallest diameters were used as the sole embolic agent in all cases. Coils were applied far distally in a stretched position for obtaining ideal target vessel superselectivity. The objective of this study is to evaluate efficacy and complications of superselective coil embolization for treatment of severe intractable epistaxis and to discuss results from an otorhinolaryngologic and an interventional neuroradiologic point of view. Retrospectively, all epistaxis inpatients between 2006 and 2013 were identified and subdivided by form of treatment: conservative, surgical and interventional therapy. Medical records of interventionally treated patients were reviewed for demographics, medical history, risk factors, clinical data, complications and short-term success, and patients were followed up for long-term success. Mean follow-up was 37 months. In 12 patients, 14 embolizations were carried out, with short-term success in 9 patients (75%), while early post-interventional rebleeding occurred in 3 patients (25%). Of 9 patients with short-term success, 1 died during stay, 1 was lost to follow-up and 1 had minor re-bleeding after 30 months. Six patients had short-term and long-term success. Before the first embolization, 3 ± 1 conservative and/or surgical procedures had been undertaken. Length of stay was 12.8 ± 3.6 days. 8 patients (67%) received red cell concentrates. Most frequent complications were mucosal damage and nasal pain, but these were related to repeated packing and surgery. Typical embolic complications as neurological or visual impairment or soft tissue necrosis were not observed in any patient. From the otorhinolaryngologic point of view, surgery is the treatment of choice in severe refractory epistaxis, but in case of repeated failure, superselective microcoil embolization is a valuable addition to the therapeutic spectrum. From the interventional neuroradiologic point of view, superselective microcoil embolization is an effective, well tolerable and safe procedure and complications may be reduced in comparison to microparticle embolization. Modern supersoft microcoils with smallest diameters enable ideal superselectivity of the target vessels.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Malteser Hospital St. Anna, Albertus-Magnus-Straße 33, 47259, Duisburg, Germany. daviduseidel@web.de.
authors.forename: D U
authors.initials: DU
authors.lastname: Seidel
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Malteser Hospital St. Anna, Albertus-Magnus-Straße 33, 47259, Duisburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Remmert
authors.affiliation: Department of Radiology and Neuroradiology, Klinikum Duisburg-Sana Kliniken, Zu den Rehwiesen 9, D-47055, Duisburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Brassel
authors.affiliation: Department of Radiology and Neuroradiology, Klinikum Duisburg-Sana Kliniken, Zu den Rehwiesen 9, D-47055, Duisburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schlunz-Hendann
authors.affiliation: Department of Radiology and Neuroradiology, Klinikum Duisburg-Sana Kliniken, Zu den Rehwiesen 9, D-47055, Duisburg, Germany. dan.meila@sana.de.|Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Germany. dan.meila@sana.de.
authors.forename: D
authors.initials: D
authors.lastname: Meila
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D004621:Embolization, Therapeutic / Q000379:methods; D004844:Epistaxis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000098:blood supply; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Angiography; Complications; Endovascular intervention; Internal maxillary artery; Intractable epistaxis; Microcoils; Sphenopalatine artery; Superselective embolization