title: Transarterial Embolization in Maxillofacial Intractable Potentially Life-Threatening Hemorrhage.
abstract: OBJECTIVE
  Although transarterial embolization (TAE) of vascular lesions with embolizing agents through angiographic catheters has been used for more than 45 years, reports of life-threatening maxillofacial bleeding are relatively rare and have not been updated. The authors review treatment modalities, present their experience of the past 21 years, and suggest a comprehensive algorithm and guidelines for the use of TAE in the treatment of intractable life-threatening maxillofacial hemorrhage.
  
  
  METHODS
  This article describes 28 patients treated with TAE for severe bleeding that did not respond to conservative therapies. Of these, 13 had uncontrolled epistaxis, 9 were oncologic patients, 4 were postsurgical patients, and 2 were trauma patients.
  
  
  RESULTS
  Details of patients' medical history, failed conservative therapy administered before TAE, imaging results, and blood vessels involved are presented, as are the TAE procedures and materials used, outcome, and complications. All these are discussed in relation to the available updated literature. All 9 oncologic patients (100%) had been treated with chemotherapy before the uncontrolled bleeding, and 7 also had radiotherapy administered to the maxillofacial region. Continuous anticoagulant therapy also seemed to predict such bleeding episodes. TAE resolved the bleeding in all 28 cases and rapidly in 90% of cases. Only in 3 oncologic cases did continued bleeding require 3 to 4 consecutive TAE sessions and combinations of embolizing agents.
  
  
  CONCLUSIONS
  The reported high rate of success could be the result of careful techniques, appropriate preoperative imaging, highly professional personnel, and intraoperative and perioperative treatments.
authors.affiliation: Senior Physician, Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Clinical Research Institute, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Dani
authors.initials: D
authors.lastname: Noy
authors.affiliation: Senior Physician, Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Clinical Research Institute, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Rachmiel
authors.affiliation: Senior Physician, Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Clinical Research Institute, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Omri
authors.initials: O
authors.lastname: Emodi
authors.affiliation: Senior Interventional Radiologist, Department of Interventional Neuroradiology, Rambam Medical Center, Clinical Research Institute, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Amsalem
authors.affiliation: Senior Physician, Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Clinical Research Institute, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Israel
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Clinical Research Institute, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: TobieK@gmc.gov.il.
authors.forename: Rafael M
authors.initials: RM
authors.lastname: Nagler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods*; D004844:Epistaxis / Q000000981:diagnostic imaging / Q000628:therapy; D005151:Facial Injuries / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome