Arterial embolization in the management of posterior epistaxis

Nathan P. Christensen, Dana S. Smith, Stanley L. Barnwell, Mark Wax

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

OBJECTIVES: Treatment of severe epistaxis can encompass many modalities. Control rates with all treatments are good. Morbidity among treatment groups varies. Angiographic embolization is one such method that has a very low complication rate. Over the last 10 years, it has become the preferred treatment at our institution. STUDY DESIGN: Tertiary medical referral centers: OHSU, Portland VAMC. MATERIALS AND METHODS: Retrospective review of 70 patients transferred or admitted with posterior epistaxis and treated with selective angiographic embolization from 1993 to 2002. RESULTS: Patients had bleeding for a median of 4.5 days prior to admission. 79% were unilateral. Etiology of bleeding was: idiopathic (61%), previous surgery (11%), anticoagulants (9%), trauma (7%), and other causes (12%). 30% required blood transfusions prior to admission to OHSU (average 4.4 units). No patient required a transfusion postoperatively following angiographic embolization or during their hospitalization. The internal maxillary artery (IMAX) was embolized in 94% (47% unilateral or bilateral IMAX only, 47% unilateral or bilateral IMAX in combination with other vessels, 6% other vessels besides the IMAX). Mean length of stay was 2.5 days. 86% had minor or no complications after the embolization and were discharged within 24 hours. 13% had a major rebleed that required surgical intervention within 6 weeks of the embolization. One patient had a serious neurological complication. Using the data available on 68 of 70 patients, the cost of hospitalization averaged $18,000 with direct costs of embolization averaging $11,000. CONCLUSIONS: Angiographic embolization is a clinically effective treatment for severe epistaxis. EBM RATING: C.

Original languageEnglish (US)
Pages (from-to)748-753
Number of pages6
JournalOtolaryngology - Head and Neck Surgery
Volume133
Issue number5
DOIs
StatePublished - Nov 2005

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Epistaxis
Maxillary Artery
Hospitalization
Hemorrhage
Therapeutics
Costs and Cost Analysis
Tertiary Care Centers
Blood Transfusion
Anticoagulants
Length of Stay
Morbidity
Wounds and Injuries

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Arterial embolization in the management of posterior epistaxis. / Christensen, Nathan P.; Smith, Dana S.; Barnwell, Stanley L.; Wax, Mark.

In: Otolaryngology - Head and Neck Surgery, Vol. 133, No. 5, 11.2005, p. 748-753.

Research output: Contribution to journalArticle

Christensen, Nathan P. ; Smith, Dana S. ; Barnwell, Stanley L. ; Wax, Mark. / Arterial embolization in the management of posterior epistaxis. In: Otolaryngology - Head and Neck Surgery. 2005 ; Vol. 133, No. 5. pp. 748-753.
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