The Endovascular Treatment of Epistaxis (original) (raw)
Related papers
[Endovascular treatment of epistaxis]
Journal of neuroradiology. Journal de neuroradiologie, 1998
Epistaxis or nosebleed is relatively common in the general population. Depending on the location of the bleeding in the nasal cavity, epistaxis can be divided in two types: anterior or posterior type. The anterior type is far more frequent, often self-limiting and, if needed, is relatively easy treatable. Posterior type epistaxis is rare and more likely to require medical attention. The cornerstone of the conservative therapy of posterior epistaxis is nasal packing. Only in patients with persistent or recurrent epistaxis, endovascular intervention or surgery is indicated. Both treatment options have a similar success and complication rate, but endovascular treatment, if feasible, has several advantages above surgical treatment. The choice of procedure should be made on a patient-to-patient basis, taking several parameters into account. In this pictorial essay we present an overview of the relevant radiological anatomy and a review of various causes of epistaxis, with the emphasis on the endovascular treatment.
Surgical treatment of nasal packing refractory epistaxis
Brazilian Journal of Otorhinolaryngology (Impresso), 2009
Epi staxis is the main otorhinolaryngology emergency and, in severe cases, it can lead to hemodynamic instability and be life threatening. Aim: To evaluate factors involved in epistaxis resistant to nasal packing that needed surgical treatment, as well as post-surgical results. Material and Methods: Retrospective study from January 2002 to August 2007. 40 consecutive patients that underwent surgical treatment for refractory epistaxis were analyzed. Predisposing factors, procedures performed, need of blood transfusion, and recurrence were evaluated. Results: Otorhinolaryngology post operative complications (37.5%), high blood pressure (30%), and coagulopathy (15%) were the main factors related to epistaxis. 50% of the patients (n=20) presented with hemodynamic instability and 90% of them (n=18) needed blood transfusion. Eletrocauterization of the bleeding site was enough in 35% of these patients (n=14), while in 65% (n=26) was necessary cauterization and/or arterial ligation. Five patients (12.5%) had bleeding recurrence, which needed re-operation. Conclusion: Earlier indications of surgical treatment to control severe and refractory epistaxis to conventional treatment, especially in a population with high risk such as post operative bleeding and coagulopathies, may decrease the need of blood transfusion.
Nasal endoscopy and localization of the bleeding source in epistaxis: last decade's revolution
Brazilian Journal of Otorhinolaryngology, 2005
Epistaxis remains one of the most common otolaryngology emergencies. Despite considerable interest in the subject, there is still no consensus on the most appropriate primary therapeutic modality. Aim: The purpose of this study was to evaluate the bleeding source of acute or recurrent epistaxis in adults. Study Design: Clinical prospective. Material and Method: Thirty adults patients with acute or recurrent epistaxis were evaluated through the use of frontal light and endoscope for identification of the bleeding source in the nasal cavity. Results: Use of the nasal endoscope allowed diagnosis of the bleeding site in all patients. Conclusion: A careful examination of the posterior nasal cavity allows identification of the bleeding source in most patients and should be a routine procedure.
A Study of Role of Nasal Endoscopy in the Diagnosis and Management of Epistaxis
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND Epistaxis is one of the most common emergencies in any ENT Department, which needs utmost attention and early intervention. If proper assessment on arrival of the patient is not done, a significant morbidity and mortality can occur. MATERIALS AND METHODS All epistaxis patients were subjected to nasal endoscopy under Local or General Anaesthesia on arrival in Emergency Ward. The most useful and definitive method to find out the bleeder in epistaxis is nasal endoscopy and electrocautery. A three-year retrospective clinical study of management of epistaxis with endoscopic cauterisation was done from July 2013 to July 2016 in the Department of ENT in MGM Medical College and LSK Hospital, Kishanganj, for 180 patients. RESULTS In most of the epistaxis patients, bleeding was controlled with nasal endoscopy and cautery successfully. CONCLUSION The study was conducted to establish the fact that the best way to manage epistaxis is by doing nasal endoscopy at the first outset to find out the bleeder and cauterise. It reduces cost, hospital stay and complications of nasal pack. Findings in our study for the site of bleeder will be a guide to the surgeon for successful control of epistaxis in a tense situation of active bleeding.
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Epistaxis is the most common emergency in otorhinolaryngology. The usual treatment in most cases of anterior epistaxis and almost all cases of posterior epistaxis is nasal packing followed by either cauterization, embolization or ligation. This study has been undertaken to evaluate the use of nasal endoscopic cauterization as the first line treatment both in anterior as well as posterior epistaxis. MATERIALS AND METHODS The study consisted of total 36 patients, who presented with epistaxis. All patients were first managed with nasal endoscopy and endoscopic electrocautery. Only the patients in which bleeding point could not be located by initial endoscopy were managed by insertion of nasal packing. The discomforts and minor complications in patients undergoing successful endoscopic cauterization and in the patients who were taken for nasal packing were observed along with average stay of patient in the hospital. RESULTS Out of total 36 patients, 28 patients (78%) could be successfully managed directly by endoscopic cauterization without undergoing nasal packing and the obvious discomfort associated with it. The average length of hospital stay in the patients without nasal pack was 1.39 days while for patients who were managed by nasal packing the average length of hospital stay was around 3 days. The patients who underwent nasal packing, 5 (62%) had minor complications. While in patients with endoscopic treatment as first line management, no such complications were observed. CONCLUSION Along with a good success rate, endoscopic cauterization is very effective in reducing the nasal packing related complications and the duration of stay of patient in the hospital, thus reducing the cost of treatment as well. This makes endoscopic cauterization a better first line management for both anterior as well as posterior epistaxis.
Diagnosis and Management of Epistaxis: A Summary from Recent Systematic Reviews
https://www.ijhsr.org/IJHSR\_Vol.7\_Issue.3\_March2017/IJHSR\_Abstract.049.html, 2017
Epistaxis is a common condition of nose, self limited or it subsides with simple measure, some do not resolve without intervention and in some cases it can cause of life threatening. It is rare in neonates and common in males. Bleeding is peaks in the morning and late afternoon. It often associated with changes in temperature and humidity in atmosphere. The cause of epistaxis can be divided into local, systemic, environmental, medications or, in the majority of cases idiopathic. Epistaxis can be classified by its anatomical location into anterior and posterior epistaxis. Anterior epistaxis is more common than posterior epistaxis. Flexible or rigid endoscopic examination is helpful to attempt to identify the site. The treatment options will be divided into medical, nonsurgical, and surgical options. Anterior epistaxis is controlled by local pressure or anterior nasal packing, while posterior epistaxis often requires posterior nasal packing or arterial ligation. There are three main types of surgical options: external carotid artery ligation, internal maxillary artery ligation or Sphenopalatine artery ligation. Endonasal ligation of the SPA is the most specific and currently the most widely used technique.
The Ochsner journal, 2010
A 70-year-old man presented with right-sided epistaxis that had been unrelieved by direct pressure for the past 90 minutes. His medical history was significant for hypertension (blood pressure was 180/ 100 mmHg on arrival), atrial fibrillation, and coronary artery disease. His current medications are aspirin, warfarin, enalapril, and metoprolol tartrate. On placement of an anterior nasal pack on the right side, the patient began bleeding heavily from the left side.