血管造影栓塞术治疗顽固性鼻出血

为探讨血管造影栓塞术治疗顽固性鼻出血的疗效，对８例经多次后鼻孔填塞失败的顽固性鼻出血患者，在荧光屏透视下行超选择血管栓塞术９次，全部栓塞成功，无一例出现严重并发症。表明血管栓塞术是一种安全，有效的止血方法，尤其对全长或伴有其它疾病的无罪性鼻出血患者，在保守治疗失败的情况下，该术式是治疗的最佳选择。     

Severe late-onset epistaxis following Le Fort I osteotomy: angiographic localization and embolization

Epistaxis following maxillofacial trauma or maxillofacial surgery is uncommon. It usually occurs within 24 hours of the injury and can usually be controlled by packing. Rarely internal maxillary artery ligation is necessary and embolization has been used in some cases of severe trauma. We present a case of severe late-onset epistaxis following Le Fort I osteotomy. The diagnostic approach and treatment are discussed.     

Percutaneous embolization to control epistaxis in Rendu-Osler-Weber disease.

Recurrent epistaxis is the most common manifestation of hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease), a disorder characterized by widely scattered visceral, dermal, and mucosal vascular lesions. Emergency measures applied locally may control acute hemorrhage, but seldom result in long-term benefit. Recently, we have had the opportunity of performing bilateral carotid angiographic examination on a patient with hereditary hemorrhagic telangiectasia who was suffereing from severe intractable epistaxis. At the time of angiographic examination, embolization of both internal maxillary arteries was accomplished, and control of the epistaxis was achieved. In the patient with severe epistaxis that is unresponsive to local measures, percutaneous embolization offers substantial advantages over surgical intervention.     

Transarterial embolization to control posterior epistaxis

Posterior nasal epistaxis is a challenging problem for the oto-laryngologist, particularly when patients are critically ill after significant blood loss. The purpose of this paper is to describe a new radiologic technique designed to enhance the treatment of acute nasal hemorrhage. Seven patients with posterior nasal epistaxis underwent portable, computerized, digital subtraction angiography before embolization. Results are presented, and the advantages and limitations of this approach are compared and contrasted with those of nasal packing and arterial ligation. We conclude that this new procedure permits rapid location of the bleeding source and safe, rapid placement of a maxillary arterial catheter for hemostasis by embolization.     

Percutaneous embolization to control intractable epistaxis

Recurrent epistaxis is a common manifestation of patients with a bleeding diathesis. Two patients with epistaxis secondary to a bleeding diathesis managed by local conservative techniques are reviewed. (A case of polycythemia vera and a case of liver failure secondary to hepatoma are reviewed.) Recently bilateral, percutaneous carotid angiography examination was performed on a patient with a bleeding diathesis and intractable epistaxis. At the time of the angiographic examination, embolization of both internal maxillary arteries with Gelfoam particles was accomplished and dramatic control of the epistaxis was achieved. In a patient with severe epistaxis secondary to a bleeding diathesis that is unresponsive to local measures, percutaneous Gelfoam embolization offers substantial advantages over surgical intervention.     

Superselective angiographic embolization for intractable epistaxis

CONCLUSIONS: Routine embolization of the ipsilateral facial artery (FA) is effective because of the high success rate. The use of different embolic materials for the internal maxillary artery (IMA) and the FA was considered safe because of the absence of major complications. OBJECTIVE: To evaluate outcomes of routine embolization of the FA as well as the IMA ipsilateral to the bleeding site for intractable epistaxis, and outcomes using different embolic materials for the FA and the IMA. PATIENTS AND METHODS: Twenty-two patients with intractable epistaxis who underwent superselective embolization were retrospectively analyzed with a mean follow-up of 7 months. The FA and the IMA ipsilateral to the bleeding site were embolized. Two embolic materials, gelatin sponge and microcoils, were used for the IMA and the FA, respectively. RESULTS: The short-term success rate within the first 7 days was 77.3% (17/22). The long-term success rate was 95.5% (21/22). There were no major complications in 22 cases. Minor complications occurred in 13 cases (59%). These minor complications usually did not last more than a week and most resolved within a day.     

Postraumatic massive epistaxis. An indication for selective arterial embolization

We report a 38 years old male admitted to our hospital with massive epistaxis secondary to nasal trauma which required to perform a posterior packing, transfusion and embolization of the internal maxillary artery for stopping the nosebleed. Then we made a FENS (Functional Endoscopic Nasal Surgery) by cauterization of several bleeding points on nasal septum following an anterior packing that was removed after 48 hours without new epistaxis. In a patient like this we think that an angiography with selective embolization is the main choice when other options have failed.     

Treatment of intractable epistaxis using arterial embolization

Arterial embolization has become the procedure of choice for managing intractable epistaxis in certain centres in North America and Europe, with arterial ligation reserved for those patients in which it fails. In Ireland, the role of this relatively new technique is poorly defined. The aim of this retrospective study was to investigate the outcome of all patients who underwent arterial embolization for intractable epistaxis in Dublin since it was introduced in 1998. Embolization resulted in complete and immediate resolution of epistaxis in 10 out of 12 patients (82%). Two patients required carotid ligation because of persistent epistaxis. One other patient had a further minor epistaxis 2 days following embolization, which was treated successfully with cautery. No major complications occurred in any of the patients. This study suggests that arterial embolization is an effective and safe method of managing patients with intractable epistaxis.     

Angiography and embolization of the internal maxillary artery for posterior epistaxis.

Epistaxis that originates from the posterior aspect of the nasal cavity is most often due to hemorrhage from one of the branches of the internal maxillary artery. There are multiple methods of treatment of this problem that vary in effectiveness, complexity, and stress on the patient. Most cases are controlled with either packing or surgical arterial ligation, but occasionally patients either cannot tolerate this therapy or continue to hemorrhage. We describe ten patients who were referred to the Neuroradiology Section of the Massachusetts General Hospital from the Massachusetts Eye and Ear Infirmary for angiography and embolization of the internal maxillary artery for epistaxis.     

Selective embolization in the treatment of intractable epistaxis

CONCLUSIONS: In skilled hands, selective embolization is a safe procedure and represents an effective treatment for prolonged epistaxis. Embolization therapy can be repeated if necessary. OBJECTIVE: Severe posterior epistaxis is a common clinical problem in an ENT department and controlling the bleeding may present difficulties. Several methods are used to control posterior epistaxis, one of the latest treatment strategies being selective embolization of the nasal arteries. The aim of this study was to describe the effect of selective embolization in 22 patients treated with a total of 30 procedures at the ENT Department of Odense University Hospital between January 1995 and March 2004. To our knowledge this is the first Nordic work in which selective embolization has been used as a treatment strategy for patients with hereditary hemorrhagic telangiectasia (HHT). MATERIAL AND METHODS: This was a retrospective review. Post-treatment effects and complications were evaluated by means of a questionnaire and a telephone interview. Owing to the different treatment strategies used, the results were evaluated for 2 groups of patients: Group A, 9 patients with HHT; and Group B, 13 patients with causes of epistaxis other than HHT. RESULTS: In Group A, 15 procedures were performed, 12 of which were beneficial as the duration and number of episodes of epistaxis were reduced. In Group B, 15 procedures were performed and the success rate was 87%. One patient suffered from skin necrosis at the tip of the nose. No other serious side-effects of the treatment were observed.     

Selective embolization in the treatment of intractable epistaxis

Conclusions. In skilled hands, selective embolization is a safe procedure and represents an effective treatment for prolonged epistaxis. Embolization therapy can be repeated if necessary. Objective. Severe posterior epistaxis is a common clinical problem in an ENT department and controlling the bleeding may present difficulties. Several methods are used to control posterior epistaxis, one of the latest treatment strategies being selective embolization of the nasal arteries. The aim of this study was to describe the effect of selective embolization in 22 patients treated with a total of 30 procedures at the ENT Department of Odense University Hospital between January 1995 and March 2004. To our knowledge this is the first Nordic work in which selective embolization has been used as a treatment strategy for patients with hereditary hemorrhagic telangiectasia (HHT). Material and methods. This was a retrospective review. Post-treatment effects and complications were evaluated by means of a questionnaire and a telephone interview. Owing to the different treatment strategies used, the results were evaluated for 2 groups of patients: Group A, 9 patients with HHT; and Group B, 13 patients with causes of epistaxis other than HHT. Results. In Group A, 15 procedures were performed, 12 of which were beneficial as the duration and number of episodes of epistaxis were reduced. In Group B, 15 procedures were performed and the success rate was 87%. One patient suffered from skin necrosis at the tip of the nose. No other serious side-effects of the treatment were observed.     

超选择性血管栓塞术治疗严重鼻出血

目的 探讨超选择性血管栓塞术治疗严重鼻出血的效果。方法 回顾性分析1995年7月-2000年10月采用超选择性血管栓塞术治疗常规方法不能控制的6例严重鼻出血,总结经验和教训。结果 5例一次栓塞成功,1例因栓塞物返流并发脑梗塞死亡。结论 超选择性血管栓塞术可直视下辨明出血血管,栓塞效果显著,但有严重并发症的潜在危险,应严格掌握适应证。     

难治性鼻出血的出血部位及治疗

目的探讨难治性鼻出血常见的出血部位及治疗方法。方法对92例常规鼻内镜检查未发现出血点，并经规范的鼻腔填塞未能控制的鼻出血患者的出血部位、与年龄的关系及疗效进行回顾性分析。结果出血部位依次为：下鼻道顶部56．5％(52／92)、嗅裂鼻中隔部27．2％(25／92)、中鼻道后上部8．7％(8／92)及部位不明者7．6％(7／92)。出血部位与年龄有一定的相关关系，49岁以下年龄组以下鼻道顶部出血最为常见(67．3％，37／55)，50～59岁年龄组下鼻道顶部与嗅裂鼻中隔区出血分别为46．4％(13／28)及35．7％(10／28)；而在60岁以上则以嗅裂鼻中隔区出血比例最高(77．8％，7／9)。92例中，除8例嗅裂鼻中隔部出血行明胶海绵填塞及1例中鼻道出血因电凝止血失败而施行血管造影颌内动脉栓塞外，其余83例均采用电凝止血。全部病例1次治愈82例(89．1％)，2次9例(9．8％)，4次1例(1．1％)，随访l～3个月无复发。结论鼻内镜技术结合中、下鼻甲骨折移位对探查鼻腔深部的出血点具有重要意义，对出血部位进行准确电凝或填塞，是止血成功的关键。     

Place of embolization in the treatment of severe epistaxis

On the basis of long-term study on embolization for severe epistaxis, the authors show the different indications and results of this relatively new method; and 54 cases are presented including Rendu-Osler diseases, primary and traumatic epistaxis, or those due to vascular malformation and benign or malignant tumors. Embolization can prove a very effective method in most cases.     

Superselective embolization for intractable epistaxis: experiences with 19 patients

Twenty-eight patients with intractable nose-bleeds were treated with either superselective embolization and/or surgery between 1983 and 1986. The follow-up time ranged between 6 months and 3 years. The results for the 2 groups were similar. The success rate for embolization was 74% and that for surgery 65%. Complications however, were more frequent after embolization, (i.e. facial nerve paralysis, soft tissue necrosis). Surgery is recommended as the treatment of choice in intractable nose-bleeds, until therapeutic embolization techniques have been further refined and the complication rate reduced.     

选择性血管内栓塞治疗难治性鼻出血的临床分析

目的：了解选择性血管内栓塞治疗难治性鼻出血的疗效及影响疗效的因素。方法：23例难治性鼻出血患者在颈动脉数字减影血管造影(DSA)的基础上行选择性颌内动脉末梢病变血管内栓塞，其中5例同时栓塞面动脉。结果：DSA证实23例患者均存在颌内动脉末梢发育不良或畸形，15例伴有出血征象，6例并面动脉形态异常。治愈22例，其中l例24h内复发鼻出血者证实有新侧支供血，经补加栓塞后出血停止，治愈率为95．6％。l例治疗失败，与栓塞前去除鼻腔填塞物有关，且不能除外有面动脉出血。结论：难治性鼻出血与颌内动脉发育不良及畸形有关，选择性血管内栓塞治疗能收到迅速而满意的疗效。治疗失败与潜在侧支开放或面动脉出血有关，过早去除鼻腔填塞物也是影响栓塞疗效的因素。     

Acute ischemia of the parotid gland and auricle following embolization for epistaxis

We report a case of ischemia of the auricle and acute parotitis that developed following embolization for epistaxis. A 53‐year‐old male was previously conservatively treated for epistaxis with bilateral posterior nasal packing due to hypertension. As the bleeding, continued the patient underwent bilateral embolization of the internal maxillary arteries. The bleeding was controlled but the patient developed acute ischemia of the ipsilateral parotid gland and the auricle that regressed with medical treatment. Laryngoscope, 2012     

Hard palate necrosis after bilateral internal maxillary artery embolization for epistaxis

Superselective embolization is an effective method of treating epistaxis that is refractory to conservative treatment. Soft tissue necrosis is a rare complication owing to the extensive collateral blood supply of the head and neck. We describe the case of a patient who developed unilateral necrosis of the mucosa overlying the hard palate after undergoing bilateral internal maxillary artery embolization. The presence of a nasopharyngeal balloon and bilateral nasal packs for 2 days after embolization may have compressed collateral vessels in the soft palate and nose and contributed to this complication. Packing should be removed as soon as possible after embolization.     

超选择性颈外动脉分支栓塞术在难治性鼻出血中的应用

目的:探讨经微导管超选择性颈外动脉分支栓塞术在治疗难治性鼻出血中的应用价值。方法:46例难治性鼻出血患者,首选超选择性颈外动脉分支栓塞术者36例,首选颈外动脉结扎者10例。结果:36例首选颈外动脉分支栓塞术者1次性治愈32例(88.9%),10例首选颈外动脉结扎者1次性治愈4例(40.0%)。前者平均住院4.8d,后者平均住院10d。复发患者均经综合方法有效止血,并发症少。结论:经微导管超选择性颈外动脉分支栓塞术治疗难治性鼻出血简便、安全、有效,疗效明显优于颈外动脉结扎,综合运用多种方法能有效治疗难治性鼻出血。