How is embolization used in the treatment of epistaxis (nosebleed)?

Updated: May 08, 2020
  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Bleeding from the ECA system may be controlled with embolization, either as a primary modality in poor surgical candidates or as a second-line treatment in those for whom surgery has failed. Patients considered candidates for embolization should be transferred to hospitals with interventional radiology capability. [23]

Preembolization angiography is performed to check for the presence of any unsafe communications between the ICA and ECA systems. Selective embolization of the internal maxillary artery [27] and sometimes the facial artery may be performed. Postprocedure angiography can be used to evaluate the degree of occlusion. The most common reason for failure is continued bleeding from the ethmoidal arteries.

A retrospective study by Wang et al indicated that transarterial embolization (TAE) can safely and successfully be used in patients with intractable epistaxis, even when etiology and angiographic findings differ among patients. TAE was effective in all 43 of the study’s patients, despite the fact that both malignant and benign etiologies and positive and negative angiographic findings were present. [28]


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