Microcatheter embolization of intractable idiopathic epistaxis

Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991 -1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and th e number of blood transfusions needed. All embolizations were done with bip lane digital subtraction angiography (DSA) equipment. The procedure was car ried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcat heters were advanced as far as possible to the distal branches of the sphen opalatine artery. Polyvinyl alcohol (PVA) particles were used for embolizat ion in most cases, while platinum coils or a combination of these two mater ials were occasionally used. The primary outcome was always assessed immedi ately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when ne cessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A cur ative outcome was achieved in 33 cases (89%). The mean duration of the proc edure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patie nts needed a blood transfusion. Slight rebleeding occurred in three patient s during the follow-up; all responded to conservative treatment. One patien t suffered two episodes of rebleeding within 2 months after primary emboliz ation. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intr actable idiopathic epistaxis. It proved both safe and effective over a rela tively long follow-up.