Evaluation of Efficacy and Complications of Arterial Embolisation in the Management of Intractable and Life-threatening Epistaxis

Objective To evaluate the complications and efficacy of arteria embolisation in the management of intractable and life threatening epistaxis. Materials and Methods From December 2001 to July 2008,fifty nine patients of intractable and life-threatening epistaxis,who had been treated with nasal cavity packing and medicine but failed underwent angiography and embolization treatment.1 to 30 days later,complications were observed to evaluate the therapeutic efficacy of arteria embolisation.Follow-up 1 to 30 days to observe the complications and therapeutic of arteria embolisation. Results 56(56/59) patients were successfully embolized with successful rate of 94.9%.1 patient had tortuous arteriae aorta and left common carotid so that could not be embolized.1 patients died of the hemorrhagic shock during angiography and 1 patient performed operation because of the large pseudoaneurysm in the internal carotid cavernous.Bleeding was completely controlled in 37 patients.18 patients developed recurrent epistaxis one week after the medical treatment.One required re-embolisation 1 month after the first procedure.29 patients had no obvious complications occured while 23 patients developed light headache,low-grade fever,maxillofacial region anaesth and gape limited.One case developed necrosis of the facial skin and severe headache after embolization.The other 3 patients resulted in hemiplegic paralysis because of cerebral embolism after embolization. Conclusion Endovascular embolisation is an effective method in the management of intractable and life-threatening epistaxis.It may appear post embolization syndrome or ischemia after embolisation.It may also lead to local necrosis if endured severe distal embolization.Dangerously it may induce to cerebral embolism.Risk can be minimized by the proper therapeutic option according to the primary disease,technique of superselective embolization,suitable embolization agent and methods.