EMBOLIZATION FOR NASAL BLEED (EPISTAXIS)

What are the indications?

Repeated episodes of severe bleeding from your nose despite adequate surgical packing and blood pressure control suggest presence of arterial-venous malformation or simply weak blood vessels at the back aspect of your nasal cavity. ENT specialist may try to cauterize (“burn”) bad arteries, but it is not always technically possible. Embolization is usually the best treatment in such a case.

Procedure

The procedure is similar to general angiography and embolization.

The interventional radiologist will, with a help of X-rays, place the tiny tube (micro catheter) into the artery of interest (a branch of the artery supplying blood to your face) and administer contrast to demonstrate the site of bleeding.

The preferred agents for occlusion of the bleeding artery are polyvinyl alcohol particles or embospheres, which will permanently occlude selected arteries.

Is there any additional risk?

The possibility that the embolization agent can dislodge into the arterial system and deprive adjacent healthy tissue of blood supply is minimal. It is avoided by the careful positioning of the micro catheter supraselectively next to the bleeding spot. The radiologist will carefully check the arteries supplying your brain and eyes to demonstrate presence of any dangerous collateral vessel and avoid complications like blindness or stroke

Sometimes, the anatomy of your external carotid artery (the one supplying blood to your face) and its branches may be too complex for the safe placement of tube. The radiologist will then try to safely occlude bigger artery for the area of interest or advice you that the procedure is not technically feasible. In that case your attending doctor will present you with the other treatment options.

Very seldom you may feel mild pain in the face 24-48 hours after the procedure, which is often treated by simply warming up the face. Sometimes it will necessitate administration of painkillers.

The other risks are similar to general angiography and embolization.

 

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