Guillaume de Bonnecaze1,2, Y Gallois3, P Chaynes4,5, F Bonneville6, A Dupret-Bories7, E Chantalat4, E Serrano3. 1. Department of Otorhinolaryngology Head and Neck Surgery, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France. guidb31@chu-toulouse.fr. 2. Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France. guidb31@chu-toulouse.fr. 3. Department of Otorhinolaryngology Head and Neck Surgery, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France. 4. Department of Anatomy, CHU Rangueil-Larrey, University of Toulouse, Toulouse, France. 5. Department of Neurosurgery, Pierre-Paul Riquet Hospital, University of Toulouse, Toulouse, France. 6. Department of Neuroradiology, Pierre-Paul Riquet Hospital, University of Toulouse, Toulouse, France. 7. Cancer Institute of Toulouse, Toulouse, France.
Abstract
PURPOSE: Epistaxis constitutes a significant proportion of the Otolaryngologist's emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis. METHODS: Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery. RESULTS: Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoïdal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors. CONCLUSIONS: A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.
PURPOSE: Epistaxis constitutes a significant proportion of the Otolaryngologist's emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis. METHODS: Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery. RESULTS: Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoïdal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors. CONCLUSIONS: A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.
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