Arterial embolization in severe epistaxis management: clinical cases

Abstract

Epistaxis is one of the most common ENT emergencies. In refractory cases to traditional measures (chemical or electrical cauterization, anterior and / or posterior packing; systemic antifibrinolytic) it may be necessary to resort to surgical ligation or arterial embolization. Through four clinical case reports, this study aims to analyze the role of arterial embolization in the treatment of severe, refractory epistaxis to initial therapeutic measures.

Endovascular embolization has application in multiple clinical situations in otorhinolaryngology showing high success rate in the treatment of refractory epistaxis. The major complications (cerebrovascular embolism and skin necrosis) are rare. The main advantages are: it is a minimally invasive procedure, it may be performed under local anaesthesia, allows a super-selective arterial obliteration and establishment of an etiological diagnosis in some cases. However, further studies, with higher levels of evidence, are required in the comparison of endovascular vs. surgical approach.