Embolization for intractable Epistaxis
Information for patients
- Intractable epistaxis is defined as any nosebleed that does not respond to those conservative measures such as nasal packing.
- Usual causes of intractable epistaxis include uncontrolled hypertension with or without focal superficial disease of the nasal passages, bleeding necrotic tumor, or bleeding vascular malformation
- Rarely, intractable epistaxis is caused by carotid artery blowout (especially in patient with history of radiotherapy for head and neck cancer)
- The procedure will be performed under local or general anesthesia and aseptic technique.
- The interventionist will puncture a blood vessel at your groin region (mostly right side) with a needle. After the needle is correctly positioned, a slender guidewire is placed through the needle into the blood vessel. The needle is then withdrawn, allowing a fine plastic tube (the catheter) to be placed over the guide wire into the blood vessel.
- Under X-ray guidance, the catheter will be advanced into your neck region and special dye (contrast medium) will be injected through the catheter and X-rays taken.
- Within this catheter, another smaller micro-catheter will be advanced into the bleeding vessel. Embolic agents such as particles, coils, or glue will then be given via the microcatheter.
- In case of carotid artery blowout which is a life-threatening emergency; placement of stent or occlusion of the internal carotid artery itself might be performed
- ll the catheters will be removed at the end of the procedure. Pressure will be applied to the groin region to stop any bleeding. The opening in the skin is then covered with a dressing.
- The duration of this procedure is different for every patient.
- Your vital signs (e.g. blood pressure, pulse) and neurological condition will be monitored during and after the procedure. Attention should be paid on the skin puncture site to make sure there is no bleeding from it.
- Overall procedure related mortality is rare (less than 2 %).
- Overall incidence of major complications that have permanent clinical implication is around 5% (except in patient with carotid blowout).
Major complications includes:
- Stroke (permanent limb weakness, numbness, visual loss)
- Retinal infarct (rare)
- Nasal septum perforation (rare)
- Cranial nerve damage, usually temporary and deficit will improve over a period of days to weeks.
- Arteriovenous fistula or pseudoaneurysm at the puncture site
- Contrast media associated nephrotoxicity
- The overall adverse reactions related to iodine-base non-ionic contrast medium is below 0.7%. The mortality due to reaction to non-ionic contrast medium is below 1 in 250,000.
- Breakage and knot forming of catheter or guidewire is very rare, this may require surgical removal.
Minor complications includes:
- Groin bruise and pain
- Complications related to contrast medium injected – rash, urticaria.
- Transient neurological deficit which is reversible within 24 hours (limb weakness, numbness)
- Transient visual loss
- Post-procedure pain, which is a common phenomenon and not necessarily indicating a true problem. It is usually self-limiting and resolves in several days.
This leaflet has been prepared by the Hong Kong Society of Interventional & Therapeutic Neuroradiology Limited.
This leaflet is intended as general information only. Nothing in this leaflet should be construed as the giving of advice or the making of a recommendation and it should not be relied on as the basis for any decision or action. It is not definitive and the Hong Kong Society of Interventional and Therapeutic Neuroradiology Limited does not accept any legal liability arising from its use. We aim to make the information as up-to-date and accurate as possible, but please be warned that it is always subject to change as medical science is ever-changing with new research and technology emerging. Please therefore always check specific advice on the procedure or any concern you may have with your doctor.
Prepared in 2010 (Version 1.0)