Recurrent epistaxis occurred shortly after superselective embolization of external carotid artery: its causes and prevention strategy

Objective To discuss the causes of recurrent epistaxis occurred shortly after superselective embolization of external carotid artery and to make some suggestions related to the prevention strategy. Methods Superselective embolization of external carotid artery was carried out in 62 patients with severe epistaxis. Recurrence occurred in 9 cases within one week and in 7 cases within two weeks after the treatment. And the selective angiography together with the embolization therapy was performed again. The initial angiograms and the detailed embolization procedures were carefully reviewed and the possible causes of epistaxis recurrence were analyzed. Results In 10 patients the recurrent epistaxis was caused by recanalization of the branches of external carotid artery. The lesions were fed by multiple branches of external carotid artery, but in 4 cases some of them were missed to be occluded in initial embolization procedure, resulting in recurrent epistaxis. In another two cases the recurrent epistaxis was caused by the establishment of collateral blood supply to the lesions. Conclusion Careful observation of angiograms to find out all feeding arteries to the lesion and complete embolization of all feeding arteries with un-absorbable embolic agents can avoid the recurrence of epistaxis. (J Intervent Radiol, 2011, 20: 645-648)