Abstract
Embolisation for epistaxis is a tutorial about the principles of embolisation to stop haemorrhage. Since patients with uncontrollable epistaxis are commonly referred to the endovascular neurosurgeon and interventional neuroradiologist, it provides a focus for discussing haemostatic methods and their application. Life-saving embolisations are more commonly performed after trauma in other parts of the body, but in the head and neck region they pose particular difficulties for the endovascular therapist. This is because of the proximity of neural structures and the risk of emboli spreading through external to internal carotid arterial connections. Techniques for stopping bleeding are described along with the specific anatomy relevant to epistaxis, its causes, diagnosis and endovascular treatment. The tutorial reinforces the vascular anatomy discussed in previous chapters of this book.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
Wilhelm Kiesselbach (1839–1902), a German otolaryngologist, is commonly attributed with describing this plexus, but James L. Little, a New York surgeon, first described the area as a source of epistaxis in 1879.
- 2.
If present the mandibular artery gives a branch which anastomoses with the Vidian artery and supplies the sphenoid sinus. Its inferior branch anastomoses with the inferior Eustachian branch of the accessory meningeal artery and the Eustachian branch of the APA and pterygovaginal arteries, i.e. at the anastomosis around the Eustachian meatus (see Tutorial 7).
References
Sokoloff J, Wickbom I, McDonald D, Brahme F, Goergen T, Goldberge L. Therapeutic percutaneous embolization in intractable epistaxis. Radiology. 1974;111:285–7.
Small M, Murray J, Maran A. Study of patients with epistaxis requiring admission to hospital. Health Bull. 1982;40:20–9.
Little JL. A hitherto undescribed lesion as a cause of epistaxis, with 4 cases. Hosp Gaz. 1879;6(March):5–6.
Viducich RA, Blanda MP, Gerson LW. Posterior epistaxis: clinical features and acute complications. Ann Emerg Med. 1995;25:592–6.
Chiu TW, Shaw-Dunn J, McGarry GW. Woodruff’s plexus. J Laryngol Otol. 2008;122:1074–7.
Wong GK, Chan KK, Yu SC, Tsang RK, Poon WS. Treatment of profuse epistaxis in patients irradiated for nasopharyngeal carcinoma. ANZ J Surg. 2007;77(4):270–4.
Willems PW, Farb RI, Agid R. Endovascular treatment of epistaxis. Am J Neuroradiol. 2009;30(9):1637–45.
Shah RK, Dhingra JK, Shapshay SM. Hereditary hemorrhagic telangiectasia: a review of 76 cases. Laryngoscope. 2002;112(5):767–73.
Soyka MB, Nikolaou G, Rufibach K, Holzmann D. On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions. Rhinology. 2011;49(4):474–8.
Vitek J. Idiopathic intractable epistaxis: endovascular therapy. Radiology. 1991;181(1):113–6.
Oguni T, Korogi Y, Yasunaga T, Sadanaga T, Uozumi H, Kawanaka K, Sumi S, Takahashi M. Superselective embolisation for intractable idiopathic epistaxis. Br J Radiol. 2000;73(875):1148–53.
Guttmacher AE, Marchuk DA, White Jr RI. Hereditary hemorrhagic telangiectasia. N Engl J Med. 1995;333(14):918–24.
Duncan IC, Van Der Nest L. Intralesional bleomycin injections for the palliation of epistaxis in hereditary hemorrhagic telangiectasia. Am J Neuroradiol. 2004;25(7):1144–6.
Gurney TA, Dowd CF, Murr AH. Embolization for the treatment of idiopathic posterior epistaxis. Am J Rhinol. 2004;18(5):335–9.
Merland JJ, Melki JP, Chiras J, Riche MC, Hadjean E. Place of embolization in the treatment of severe epistaxis. Laryngoscope. 1980;90(10):1694–704.
Elden L, Montanera W, Terbrugge K, Willinsky R, Lasjaunias P, Charles D. Angiographic embolization for the treatment of epistaxis: a review of 108 cases. Otolaryngol Head Neck Surg. 1994;111(1):44–50.
Tseng E, Narducci C, Willing S, Sillers M. Angiographic embolization for epistaxis: a review of 114 cases. Laryngoscope. 1998;108(4):615–9.
Duncan IC, Fourie PA, Le Grange CE, Van der Walt HA. Endovascular treatment of intractable epistaxis—results of a 4-year local audit. S Afr J Radiol. 2004;1:8(3).
Siniluoto TM, Leinonen AS, Karttunen AI, Karjalainen HK, Jokinen KE. Embolization for the treatment of posterior epistaxis: an analysis of 31 cases. Arch Otolaryngol. Head Neck Surg. 1993 Aug 1;119(8):837–41.
Christensen NP, Smith DS, Barnwell SL, Wax MK. Arterial embolization in the management of posterior epistaxis. Otolaryngol Head Neck Surg. 2005;133(5):748–53.
Sadri M, Midwinter K, Ahmed A, Parker A. Assessment of safety and efficacy of arterial embolisation in the management of intractable epistaxis. Eur Arch Otorhinolaryngol. 2006;263(6):560–6.
Fukutsuji K, Nishiike S, Aihara T, Uno M, Harada T, Gyoten M, Imai S. Superselective angiographic embolization for intractable epistaxis. Acta Otolaryngol. 2008;128(5):556–60.
Strong EB, Bell DA, Johnson LP, Jacobs JM. Intractable epistaxis: transantral ligation vs. embolization: efficacy review and cost analysis. Otolaryngol Head Neck Surg. 1995;113(6):674–8.
Bertrand B, Eloy P, Rombaux P, Lamarque C, Watelet JB, Collet S. Guidelines to the management of epistaxis. B-ENT. 2005;1(supplement 1):27–43.
Upile T, Jerjes W, Sipaul F, El Maaytah M, Nouraei S, Singh S, Hopper C, Wright A. The role of surgical audit in improving patient management; nasal haemorrhage: an audit study. BMC Surg. 2007;7:19.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Byrne, J.V. (2017). Embolisation for Epistaxis. In: Tutorials in Endovascular Neurosurgery and Interventional Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-319-54835-7_16
Download citation
DOI: https://doi.org/10.1007/978-3-319-54835-7_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-54833-3
Online ISBN: 978-3-319-54835-7
eBook Packages: MedicineMedicine (R0)