ANGIOGRAPHIC EMBOLIZATION FOR THE TREATMENT OF EPISTAXIS - A REVIEW OF 108 CASES

Ninety-seven patients were referred to the Toronto Hospital (Western D ivision) between January 1984 and January 1992 for selective angiograp ic embolization (108 embolizations, Including repeat procedures) to co ntrol intractable or recurrent severe epistaxis. Eighty-one patients ( comprising 94 embolizations) were referred on an emergent basis becaus e of failure of conventional conservative therapy, consisting of anter ior and posterior packing. The remaining 16 patients (14 embolizations ) were referred electively for recurrent epistaxis. A retrospective re view of these cases was performed, with long-term telephone follow-up achieved in over 95% of cases. Embolization safely controlled active h emorrhage in 88% of the emergent cases. The success rate increased to 90% when two cases in which the source of epistaxis was found to be fr om the internal carotid artery were excluded (because these vessels co uld not be safely embolized). Of the patients whose epistaxis was init ially controlled by embolization, 82% had no further nosebleeds (follo w-up time ranged from 2 to 82 months; average, 26.8 months). More than half of the long-term failures were seen in patients with Osler-Weber -Rendu disease. Overall, the mortality rate was 0% and the long-term m orbidity rate was 2% (one cerebral vascular accident and one case of s kin slough in the territory of the superficial temporal artery).