Background. Epistaxis is a common consequence of craniofacial injury involving damage to the external carotid artery branches. Conservative treatment or surgical or endovascular procedures can be applied, depending on the intensity and the site of bleeding as well as on the experience of the medical team. The applicability of endovascular embolization and its efficacy in the treatment of epistaxis following craniofacial injury are discussed in this paper.
Material and methods. The study group included 22 patients (15 men, 7 women) with mean age of 41 years (range of 21–64 years), who suffered from post-traumatic epistaxis. Angiography disclosed pseudoaneurysms of the external carotid branches in 13 patients, extravasation of contrast media in 6 persons, and cavernous carotid fistulae in three patients. Based on diagnostic angiography findings, the risk related to endovascular embolization procedure was considered too high in three patients. In the remaining 19 patients, embolization was performed with the use of gelatine foam, polyvinyl alcohol, acrylic polymer, and platinum microcoils.
Results. Immediate arrest of epistaxis was achieved in all embolised patients. In four cases (20%) the bleeding recurred, of which two cases were controlled with repeated embolization. Nine patients (42%) experienced adverse effects in the form of transient facial pain and swelling, paresthesiae, trismus, and fever, which regressed within several days. Three patients (15%) had permanent sensory disturbances in the cheek area. One patient developed a small ulceration of the palate, treated conservatively with success. There were no major neurological complications.
Conclusions. Endovascular embolization is an effective method for managing post-traumatic epistaxis and should be considered when planning therapy.
Acta Angiol 2011; 17, 1: 89–97