Maxillary Artery Embolization for the Treatment of Intractable Epistaxis

Abstract

Objectives:

Arterial embolization has become a common treatment for intractable epistaxis. The objectives of this study are to evaluate the outcomes and optimal endovascular treatment strategy for patients undergoing embolization for intractable epistaxis.

Methods:

Retrospective review of patients undergoing endovascular embolization for intractable epistaxis from 2004 to 2013. Patients having tumor embolization were excluded. Vessels were embolized with polyvinyl alcohol (PVA). Data were collected concerning demographics, risk factors, management prior to embolization, vessels embolized, outcomes, and complications.

Results:

Forty-three patients underwent embolization for intractable epistaxis. Risk factors included uncontrolled hypertension (n = 20), anticoagulation therapy (n = 17), facial trauma (n = 4), and recent nasal or palate surgery (n = 5). Therapy attempted prior to embolization included anterior nasal packing (86%), nasopharyngeal balloon packing (42%), chemical cauterization (9%), surgical intervention (19%), prior embolization (7%), and oropharyngeal packing (2%). Vessels embolized were bilateral maxillary arteries (MA) (81%), bilateral MA with bilateral facial arteries (5%), and unilateral MA when bilateral embolization was not possible due to vessel anatomy (14%). Successful embolization, defined as resolution of bleeding prior to discharge, occurred in 35 patients. Of the 8 cases with postembolization bleeding, 6 stopped spontaneously or with minimal intervention. The rate of successful embolization was 83% for both unilateral and bilateral MA embolization. The only major complication was nasal tip and alar necrosis that occurred in 1 patient after facial artery embolization. No neurologic complications were identified.

Conclusions:

Maxillary artery embolization had favorable outcomes and no significant complications in the current study.