Digital subtraction angiography embolization for treatment of uncontrollable epistaxis.
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Objective To investigate the effect of digital subtraction angiographic embolization for treatment of uncontrollable epistaxis. Methods 17 patients with uncontrollable epistaxis were treated with embolization aided by digital subtraction angiography(DSA) of carotid, meanwhile the facial artery were also embolized in 3 cases. Results It was comfirmed that hypogenesis and malformation in the ends of internal maxillary artery were existed in all cases during DSA, and facial artery with abnormal shape was found in 3 cases. Nose bleeding was stopped in all cases after embolized. There no recurrent nose-bleeding was observed in all cases after a follow-up of 0.8 to 5 years and no severe complications occurred to these cases. Conclusion Angiographic embolization is a safe and effective method for stopping uncontrollable epistaxis and it is the best method in the senile patients with other diseases.Keywords:
Digital subtraction angiography
Facial artery
External carotid artery
Subtraction
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Objective To discuss the clinic value of digital subtraction angiography (DSA)and selected transarterial embolization in diagnosis and treatment of troublesome epistaxis.Methods Retrospective analysis was made on the 15 pationts with troublesome epistaxis selective artery embolization under DSA after failures of choanae packing who had been performed.Results Above-mentioned procedures were performed successfully in all the 15 patients,1 case of them was performed again,no serious complication occurred.During the following up from 1 to 24 months,no patients occurred nose bleeding.Conclusion Diagnosis and transarterial embolization under DSA are safe,effective and successful for troublesome epistaxis cavit failed through conservative way such as choanae packing,laser treatment,etc.
Digital subtraction angiography
Transarterial embolization
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To learn the effects and the correlative factors of selected transarterial embolization in treatment of uncontrolled epistaxis.The abnormal ends of internal maxillary artery were selected embolized in 23 patient of uncontrolled epistaxis by digital subtraction angiography (DSA) of carotid, meanwhile the facial artery were also embolized in 5 patients.It was confirmed that hypogenesis and malformation in the ends of internal maxillary artery were existed in all 23 cases during DSA. There was evidence of bleeding in 15 patients, and facial artery with abnormal shape was found in 6 patients. Nose-bleeding was stopped in 22 cases (95.6%) after embolized, including one had a recurrence of bleeding in 24 hours because of the foundation of new abnormal communications. The fail in one case might be related with taking out all the stuff in noses before embolization and/or bleeding facial artery.Uncontrolled epistaxis in this report might be caused by hypogenesis and malformation of internal maxillary artery. The effects of selected transarterial embolization were rapid and satisfactory. The fail in treatment might be related to foundation of new abnormal communications and bleed from facial artery. Taking out all the stuff in noses too early might also influence the effects of embolization.
Digital subtraction angiography
Facial artery
Bleed
Maxillary artery
External carotid artery
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Objective To evaluate selective angiographic diagnosis and embolization of severe epistaxis in 57 cases. Methods 41 cases with spontaneous haemorrhage,11 cases with traumatic haemorrhage, 3 cases with haemorrhage of nasopharyngeal fibroangioma, and 2 case with haemorrhage of nasopharyngeal carcinoma were included in the study. Selective angiographic diagnosis and embolization of epistaxis were performed with absorbable gelatin sponge or balloon or spring coil by using Seldinger′s method. Results 59 procedure of angiographic diagnosis and embolization were performed in 57 cases. Both maxillaris internal artery embolization was performed in 6 cases. After embolization, satisfactory results were achieved immediately in 55 cases After 6 months to 2 years′ follow up, no haemorrhage recurred.In 4 cases with traumatic haemorrhage in the face, simple maxillaris internal artery embolization was performed in 2 cases. Conclusion Selective angiographic diagnosis and embolization are safe, effective, and successful method of choices in the treatment of severe epistaxis.
Gelatin sponge
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Objective To investigate selective angiography diagnosis and superselective embolization in intractable epistaxis.Methods Under femoral artery puncture and catheter introducer leaving,bilateral common carotid artery angiography was pertormed with 4F Head-Hunt or simmons angiographic catheter.We superselectively inserted the catheter to the branch of external carotid artery after confirming the bleeding site,hemorrhagic artery and external-internal cranial dangerous anastomoses.Sponge gelfoam was used for embolic agents till completely emboliza tionarrived.Results The angiography of 8 epistaxis patients revealed bleeding artery from internal maxillary and facial artery branch.The nasal packingwere taken away immediately after the embolization,without bleeding.All the patients discharged after3~10 hospital observation,no recurrent with follow-up 2~30 months.Facialpain,swelling,limitation of open mouth,low fever appeared and released bysymptomatic treatment.No serous complication occured in this group.Conclusion Selective external carotid artery branch embolization is a safe,simple,effective and rapidmethod in the treatment with refractory epistaxis.
External carotid artery
Maxillary artery
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A retrospective analysis was made on 5 cases who had the traumatic carotid artery injury with massive epistaxis (from September 2007 to June 2011). All of them were finally diagnosed by digital substraction angiography (DSA). Among them, 2 cases of traumatic pesudoaneurysm from internal maxillary artery were embolized with polyvinyl alcohol particles and gelatin sponge. One case was carotid-cavernous fistula (CCF) with traumatic pesudoaneurysm located in the sphenoid sinus. This patient's internal carotid artery (ICA) and fistula was blocked with balloon, and then ICA was clipped proximal to the posterior communicating artery. One case with injuried ICA was treated with blocking by balloon. The pesudoaneurysm located in ICA cavernous segment of one case was embolized with coil and liquid glue. No recurrence was found after successful surgeries. Patients with massive epistaxis or recurrent epistaxis after craniofacial trauma should undergo CT angiography (CTA) or DSA examination so as to get proper diagnosis and treatment as early as possible.
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OBJECTIVE To study the diagnosis and management of epistaxis caused by traumatic pseudoaneurysm.METHODS The clinical data of 16 cases with epistaxis caused by traumatic pseudoaneurysm were retrospectively studied.There were 12 males and 4 females.Their ages ranged from 16 to 41 years with an average of 25.4 years.RESULTS All the patients were cured via digital subtraction angiogrophy(DSA) and embolization except one died.The time between the hospitalization and the DSA examinat ion was 3 to15 days.Interestingly,every patient had received anterior and posterior nasal packing one to 5 times.CONCLUSION If the anterior and posterior nasal packing were not effective to the patients with repeated and vast nasal bleeding,who had trauma history before nasal bleeding,the DSA examination should be carried out immediately to identify whether the pseudoaneurysm exists.
Pseudoaneurysm
Nasal packing
Digital subtraction angiography
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In the treatment of 8 cases of patients with uncontrollable epistaxis,we used the embolization following vascular angiographic localization. They were cured and no any seriouscomplication. Embolization is the safe and effective method of stopping uncontrollable epistaxis and is the best method in the elder patients with other diseases,under the condition of anterior and posterior nasal packing being controversial. It is the key that before embolzation we make angiography to arteries and find the bleeding vessels. The technique of embolization, superselective ambolization and so on are all important measures in the decreasing severe complications.
Severe bleeding
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Objective To evaluate the application value of digital subtraction angiography( DSA) and embolization on diagnostic and treatment for vascular diseases in otorhinolaryngology-head and neck surgery. Methods The clinical data of 35 patients including 27 cases of nasopharyngeal angiofibroma,4 cases of maxillary sinus aneurysm and 4 cases of refractory epistaxis( containing 1 case of spontaneous internal carotid cavernous fistula complicated with nasal massive hemorrhage and 1 case of nasopharyngeal carcinoma complicated with refractory epistaxis after radiotherapy) were retrospectively analyzed. The diagnosis and treatment were carried out by DSA and embolization using transarterial catheterization with seldinger technique. The applied value of DSA and embolization in these diseases was analyzed. Results The DSA and embolization succeeded in all the patients. Among 5 cases treated by simple embolization,the healing only once was seen in 1 case of internal carotid cavernous fistula and other 3 cases of refractory epistaxis,and in the other 1 case of nasopharyngeal angiofibroma,the tumor volume was obviously decreased( confirmed by image examination) after performing palliative embolization only owing to extensive destruction of base of skull and internal carotid artery blood-supply. In the rest of 26 cases of nasopharyngeal angiofibroma and4 cases of maxillary sinus aneurysm,the operations were all performed after embolization; in them,the intra-operative bleeding volume decreased obviously with mean bleeding volume of 470 ml in 28 cases; 2 cases of nasopharyngeal angiofibroma Ⅳ stage with both internal and external carotid arteries blood-supply had more intra-operative bleeding volume owing to performing embolization of external carotid only. Conclusions DSA can clearly show dynamic images of blood-supply artery,abnormal communicating branch and arterio-venous fistula in the head-neck vascular lesions and guide the choice of therapeutic method. Intravascular embolization has good therapeutic effect to refractory epistaxis of external carotid system and internal carotid cavernous fistula,and preoperative embolization can obviously decrease intra-operative bleeding and enhance safety of operation immensely for tumors with rich blood supply and needing surgery.
Angiofibroma
External carotid artery
Digital subtraction angiography
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Objective: To study the effect of digital subtraction angiographic embolization in the treatment of uncontrollable expistaxis.Methods:55 cases of patients with uncontrollable posterior epistaxis were performed superselective embolization under digital subtraction angiography.Results:They were cured without any severe complication.After 0.5～3 years follow up,none of them had recurrence.Conclusion:Digital subtraction angiographic embolization is a safe and effective method to manage uncontrollable epistaxis.It is better in the elder patients accompanied with other disease so long as its surgical indication is correctly selected.
Digital subtraction angiography
Subtraction
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In this paper,five cases of serious epistaxis treated with digital subtraction angiographic embolization were reported.In 3 cases,bilateral maxillary arteries had been embolized and in 1 case,single lateral maxillary artery and facial artery had been embolized.Bleeding in all cases were controlled after operation.Arterial embolization was a effective,safe and simple method to treat serious epistaxis.Its advantage,adaptation,embolization material,operation methods,complication and preventive methods was discussed.
Digital subtraction angiography
Maxillary artery
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