Endovascular treatment of acute and subacute hemorrhage in the head and neck

Objective: Acute and subacute hemorrhage in the head and neck often represe nt a life-threatening situation. The goal of this study is to evaluate the indications for and contributions of endovascular techniques in the diagnos is and management of such severe cases. Design: Seventy-two patients with acute or subacute intractable hemorrhage of the head and neck were treated over a period of 5 years: 2 patients had experienced trauma; in 6 cases the cause of bleeding was iatrogenic; and in 2 patients intraosseous arteriovenous malformations were manifested. Fifte en patients had tumors, 9 of whom had prior radiotherapy. Forty-seven patie nts presented with epistaxis (41 idiopathic and 6 during anticoagulation th erapy). The endovascular therapy was performed using polyvinyl alcohol part icles, fibered platinum or electrolytically detachable coils (Guglielmi det achable coils; Target Therapeutics, Fremont, Calif), a stent, glue (Ethiblo c; Ethicon GmbH, Norderstedt, Germany, and Histoacryl; B. Braun Melsungen A G, Melsungen, Germany),or with a combination of these different embolic mat erials. Results: The acute bleeding was successfully controlled in all cases. Fourt een patients (7 with epistaxis, 5 with tumors, and 2 with arteriovenous mal formations) had to be embolized more than once before the bleeding could be controlled. The idiopathic, traumatic, iatrogenic, and remaining tumoral c ases were treated only once. The long-term morbidity was 1.9%. Conclusions: Owing to the recent continuous advances in interventional radi ologic techniques, it is possible to treat both acute and subacute life-thr eatening head and neck hemorrhage most efficiently. In many cases the endov ascular therapy complements surgery.