Safety and Efficacy of Transarterial Embolization Therapy in Patients with Uncontrolled Epistaxis: A Single-Center Retrospective Observational Study

Year 2023, Volume: 6 Issue: 1, 12 - 18, 30.04.2023

Mehrdad Rezaı Mıyandoab , Bilen Onan , Ferhat Can Pişkin , Sinan Sözütok , Elvan Onan

https://doi.org/10.36516/jocass.1196446

Abstract

Aim:
This study aimed to present technical details and outcomes of endovascular treatment of patients who underwent endovascular embolization due to resistant and recurrent epistaxis in our center.
Methods:
In this study, between January 2014 and January 2020, the patients who underwent endovascular treatment due to epistaxis in the interventional radiology unit at our hospital were evaluated retrospectively.
Results:
In this study, 4 (25%) female and 12 (75%) male patients were included in 16 patients. The mean age of the patients was 56.6 ± 17.8 years. The etiologies of epistaxis of the patients were as follows; 4 (25%) patients had nasal angiofibroma, 1 (6.2%) patient had larynx carcinoma, 1 (6.2%) patient had nasopharynx carcinoma, 1 (6.2%) patient had aneurysm rupture, 1 (6.2%) patient had epistaxis due to anticoagulant use, 8 (50%) patients had idiopathic epistaxis. In total, endovascular embolization was performed in all 18 procedures performed. In all 16 patients who underwent embolization, 100% technical success was achieved during the procedure, and no complications developed in the follow-up. However, in 2 (12.5%) procedures, embolization therapy was performed for the second time due to recurrent epistaxis after embolization.
Conclusions:
In resistance and recurrent epistaxis cases, endovascular embolization is an alternative to surgical methods, a treatment method with a low risk of complications and a high success rate.

Keywords

Epistaxis, Endovascular Treatment, Embolization, Interventional Radiology

Kontrol Edilemeyen Burun Kanamasi Olan Hastalarda Transarteriyel Embolizasyon Tedavisinin Güvenliği Ve Etkinliği: Tek Merkezli Retrospektif Gözlemsel Bir Çalişma

Abstract

Amaç:
Bu çalışmanın amacı, merkezimizde dirençli ve tekrarlayan burun kanaması nedeniyle endovasküler embolizasyon uygulanan hastaların endovasküler tedavisinin teknik detaylarını ve sonuçlarını sunmaktır.
Gereç ve Yöntem: Bu çalışmada Ocak 2014-Ocak 2020 tarihleri arasında hastanemizde girişimsel radyoloji ünitesinde burun kanaması nedeniyle endovasküler tedavi uygulanan hastalar retrospektif olarak değerlendirildi.
Bulgular:
Bu çalışmada toplam 16 hastaya 4 (%25) kadın, 12 (%75) erkek hasta dahil edildi. Hastaların yaş ortalaması 56.6 ± 17.8 idi. Hastaların burun kanaması etiyolojileri şöyleydi; 4 (%25) hastada nazal anjiyofibroma, 1 (%6.2) hastada gırtlak karsinomu, 1 (%6.2) hastada nazofarenks karsinomu, 1 (%6.2) hastada anevrizma rüptürü, 1 (%6.2) hastada burun kanaması nedeniyle burun kanaması vardı. antikoagülan kullanımı için 8 (% 50) hastada idiyopatik burun kanaması vardı. Toplamda, 18 prosedürün hepsinde endovasküler embolizasyon yapıldı.
Sonuç:
Dirençli ve tekrarlayan burun kanaması vakalarında endovasküler embolizasyon cerrahi yöntemlere alternatif, komplikasyon riski düşük ve başarı oranı yüksek bir tedavi yöntemidir.

Keywords

Burun Kanaması, Endovasküler Tedavi, Embolizasyon, Girişimsel Radyoloji

References

• 1. Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician 2005; 71: 305-311. https://www.aafp.org/pubs/afp/issues/2005/0115/p305.html
• 2. Christensen NP, Smith DS, Barnwell SL et al. Arterial embolization in the management of posterior epistaxis, Otolaryngology-Head and Neck Surgery 2005;133:748-53. https://doi.org/10.1016/j.otohns.2005.07.041
• 3. Tan LKS, Calhoun KH Epistaxis. Med Clin North Am 1999;83(1):43-56. https://doi.org/10.1016/S0025-7125(05)70086-9
• 4. Willems PW, Farb RI, Agid R Endovascular treatment of epistaxis. AJNR Am J Neuroradiol. 2009;30:1637-45. https://doi.org/10.3174/ajnr.A1607
• 5. Pallin DJ, Chng YM, McKay MP, et al. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med 2005; 46: 77-81. https://doi.org/10.1016/j.annemergmed.2004.12.014
• 6. Gupta AK, Jain S, Singh DP, et al. Epistaxis: Management protocol as per etiology. AIJCR 2009;2:43-6. https://doi.org/10.5005/jp-journals-10013-1009
• 7. Fatakia A, Winters R, Amedee RG. Epistaxis: a common problem. Ochsner J 2010; 10:176-8.
• 8. Tuncer I, Doganay L, Ozturk O. Instant control of fundal variceal bleeding with a folkloric medicinal plant extract: Ankaferd Blood Stopper. Gastrointest Endosc. 2009;11:16. https://doi.org/10.1016/j.gie.2009.08.021
• 9. Huizing EH, de Groot JAM (1003). Basics. Functional Reconstructive Nasal Surgery. Thieme Medical Publishers, Stuttgart. 1-55.
• 10. Chiu T, Dunn JS. An anatomical study of the arteries of the anterior nasal septum. Otolaryngol Head Neck Surg 2006; 134: 33-6. https://doi.org/10.1016/j.otohns.2005.09.005
• 11. Elahi MM, Parnes LS, Fox AJ, et al. Therapeutic embolization in the treatment of intractable epistaxis. Arch Otolaryngol Head Neck Surg. 1995; 121(1):65-9. https://doi.org/10.1001/archotol.1995.01890010051009
• 12. Scaramuzzi NS, Walsh RM, Brennan P, et al. Treatment of intractable epistaxis using arterial embolization, Clin. Otolaryngol. 2001; 26, 307-9. https://doi.org/10.1046/j.1365-2273.2001.00476.x
• 13. Göçer C, Dursun E, Görgülü O, et al. Intractable epistaxis related to cavernous carotid artery pseudoaneurysm: Treatment of a case with covered stent, Auris Naus Larynx 2004;31;275-8. https://doi.org/10.1016/j.anl.2004.03.007
• 14. Schaitkin B, Strauss M, Houck JR. Epistaxis: Medical versus surgical therapy: comparison of efficacy, complications and economic considerations. Laryngoscope 1987;97;1392-6. https://doi.org/10.1288/00005537-198712000-00003
• 15. Klotz DA, Winkle MR, Richmon J, et al. Surgical management of posterior epistaxis: A Changing Paradigm, The Laryngoscope September, 2002;112:1577-82. https://doi.org/10.1097/00005537-200209000-00008
• 16. Mahadevia AA, Murphy KJ, Obray R, et al. Embolization for intractable epistaxis, Techniques in Vascular and Interventional Radiology 2005;8:134-8. https://doi.org/10.1053/j.tvir.2005.10.006
• 17. Beck R, Sorge M, Schneider A, et al. Current Approaches to Epistaxis Treatment in Primary and Secondary Care. Deutsches Arzteblatt international 2018;115(1-02):12–22. https://doi.org/10.3238/arztebl.2018.0012
• 18. Gilyoma JM, Chalya PL. Etiological profile and treatment outcome of epistaxis at a tertiary care hospital in Northwestern Tanzania: a prospective review of 104 cases. BMC Ear Nose Throat Disord 2011;5:11-8. https://doi.org/10.1186/1472-6815-11-8
• 19. Gifford TO, Orlandi ZZ. Epistaxis. Otolaryngologic Clinics of North America 2008; 41(3):525-36. https://doi.org/10.1016/j.otc.2008.01.003
• 20. Pope LE, Hobbs CG. Epistaxis: an update on current management. Postgrad Med J. 2005;81(955):309-14. https://doi.org/10.1136/pgmj.2004.025007
• 21. Nikolaou G., Holzmann D, Soyka MB. Discomfort and costs in epistaxis treatment. Eur Arch Otorhinolaryngol 2013;270:2239–44. https://doi.org/10.1007/s00405-012-2339-2
• 22. Oguni T, Koragi Y, Yasunaga T, et al. Superselective embolization for intractable idiopathic epistaxis, The British Journal of Radiology. 2000;73;1148-53. https://doi.org/10.1259/bjr.73.875.11144790
• 23. Seidel DU, Remmert S, Brassel F, et al. Superselective microcoil embolization in severe intractable epistaxis: an analysis of 12 consecutive cases from an otorhinolaryngologic and an interventional neuroradiologic point of view. Eur Arch Otorhinolaryngol 2015; 272(11):3317–26. https://doi.org/10.1007/s00405-014-3427-2
• 24. Hayes SB, Johnson JN, Most Z, et al. Transarterial embolization of intractable nasal and oropharyngeal hemorrhage using liquid embolic agents. J Neurointerv Surg 2015; 7(07):537–41. https://doi.org/10.1136/neurintsurg-2014-011101