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Embolization in the management of recurrent secondary post-tonsillectomy haemorrhage in children

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Abstract

Objectives

The purpose of this study was to evaluate the clinical efficacy and safety of endovascular treatment (EVT) compared with iterative surgery (IS) in paediatric patients with secondary post-tonsillectomy haemorrhage (PTH) refractory to surgical haemostasis (SH).

Methods

We retrospectively identified 424 consecutive children with secondary PTH. PTH ceased spontaneously in 215 patients, but SH was required in the remaining patients, failing in 15 cases. In these 15 children, we analyzed the benefit of EVT by comparing the outcomes of the nine patients who underwent IS with the six children who underwent an EVT.

Results

After a first attempt at surgical haemostasis failed, the success rate of additional surgical procedures was 50 % for the second procedures (6/12) and 67 % (2/3) for the third. Conversely, EVT was always successful, even though no vascular source of bleeding was found in any patient. EVT did not elicit any complications. Moreover, it tended to reduce the hospitalization duration and the number of red blood cell transfusions.

Conclusions

In the event of failure of the first attempt at surgical haemostasis in the presence of secondary PTH, our study suggests that in most instances, endovascular treatment is preferred to iterative surgical haemostasis, even if no vascular source of bleeding is found.

Key Points

• In recurrent secondary post-tonsillectomy haemorrhage, the rate of success declined with additional surgery.

• Endovascular treatment was always successful and did not elicit any complications.

• Embolization was useful even if no source of bleeding was found.

• Embolization tended to reduce hospitalization duration and red blood cell transfusions.

• Embolization may be considered as an alternative option to iterative surgery.

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Acknowledgements

The scientific guarantor of this publication is Olivier Naggara. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Ear, Nose and Throat, Université Paris Descartes, Sorbonne Paris Cité, Necker-Enfants Malades Hospital, Paris, France

    Maxime Gratacap & Vincent Couloigner

  2. Department of Pediatric Neuroradiology, Université Paris Descartes, Sorbonne Paris Cité, Necker-Enfants Malades Hospital, Paris, France

    Francis Brunelle & Olivier Naggara

  3. Department of Neuroradiology, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR894, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75014, Paris, France

    Gregoire Boulouis, Jean-François Meder & Olivier Naggara

Authors
  1. Maxime Gratacap
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  2. Vincent Couloigner
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  3. Gregoire Boulouis
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  4. Jean-François Meder
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  5. Francis Brunelle
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  6. Olivier Naggara
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Correspondence to Olivier Naggara.

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Gratacap, M., Couloigner, V., Boulouis, G. et al. Embolization in the management of recurrent secondary post-tonsillectomy haemorrhage in children. Eur Radiol 25, 239–245 (2015). https://doi.org/10.1007/s00330-014-3387-3

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  • DOI: https://doi.org/10.1007/s00330-014-3387-3

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