Management of Complications Following Embolization for Intractable Epistaxis

  • Raghav Gupta
  • Aakash M. Shah
  • Fawaz Al-Mufti
  • Chirag D. GandhiEmail author


Epistaxis affects an estimated 60% of people during their lifetime [1, 2]. It is found to occur most often from an anterior source rather than a posterior source [3]. The underlying etiology for epistaxis can vary from a systemic disease with an associated coagulopathy [4], to physical assault with trauma to the mucosa, nasal bone or septum, anticoagulant use, an underlying arteriovenous malformation, illicit drug use, hypertension, and/or an underlying malignancy [1, 5].


  1. 1.
    Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med. 2009;360(8):784–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Viehweg TL, Roberson JB, Hudson JW. Epistaxis: diagnosis and treatment. J Oral Maxillofac Surg. 2006;64(3):511–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Dubel GJ, Ahn SH, Soares GM. Transcatheter embolization in the management of epistaxis. Semin Intervent Radiol. 2013;30(3):249–62.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Awan MS, Iqbal M, Imam SZ. Epistaxis: when are coagulation studies justified? Emerg Med J. 2008;25(3):156–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Herkner H, Laggner AN, Mullner M, et al. Hypertension in patients presenting with epistaxis. Ann Emerg Med. 2000;35(2):126–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Sokoloff J, Wickbom I, McDonald D, Brahme F, Goergen TC, Goldberger LE. Therapeutic percutaneous embolization in intractable epistaxis. Radiology. 1974;111(2):285–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Willems PW, Farb RI, Agid R. Endovascular treatment of epistaxis. AJNR Am J Neuroradiol. 2009;30(9):1637–45.CrossRefPubMedGoogle Scholar
  8. 8.
    Cohen JE, Moscovici S, Gomori JM, Eliashar R, Weinberger J, Itshayek E. Selective endovascular embolization for refractory idiopathic epistaxis is a safe and effective therapeutic option: technique, complications, and outcomes. J Clin Neurosci. 2012;19(5):687–90.CrossRefPubMedGoogle Scholar
  9. 9.
    Shah QA. Bilateral tri-arterial embolization for the treatment of epistaxis. J Vasc Interv Neurol. 2008;1(4):102–5.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Luo CB, Teng MM, Lirng JF, et al. Endovascular embolization of intractable epistaxis. Zhonghua Yi Xue Za Zhi (Taipei). 2000;63(3):205–12.Google Scholar
  11. 11.
    Elden L, Montanera W, Terbrugge K, Willinsky R, Lasjaunias P, Charles D. Angiographic embolization for the treatment of epistaxis: a review of 108 cases. Otolaryngol Head Neck Surg. 1994;111(1):44–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Tseng EY, Narducci CA, Willing SJ, Sillers MJ. Angiographic embolization for epistaxis: a review of 114 cases. Laryngoscope. 1998;108(4 Pt 1):615–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Duncan IC, Fourie PA, le Grange CE, van der Walt HA. Endovascular treatment of intractable epistaxis—results of a 4-year local audit. S Afr Med J. 2004;94(5):373–8.PubMedGoogle Scholar
  14. 14.
    Oguni T, Korogi Y, Yasunaga T, et al. Superselective embolisation for intractable idiopathic epistaxis. Br J Radiol. 2000;73(875):1148–53.CrossRefPubMedGoogle Scholar
  15. 15.
    Gottumukkala R, Kadkhodayan Y, Moran CJ, de Cross WT III, Derdeyn CP. Impact of vessel choice on outcomes of polyvinyl alcohol embolization for intractable idiopathic epistaxis. J Vasc Interv Radiol. 2013;24(2):234–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Fukutsuji K, Nishiike S, Aihara T, et al. Superselective angiographic embolization for intractable epistaxis. Acta Otolaryngol. 2008;128(5):556–60.CrossRefPubMedGoogle Scholar
  17. 17.
    Bilbao JI, Martinez-Cuesta A, Urtasun F, Cosin O. Complications of embolization. Semin Intervent Radiol. 2006;23(2):126–42.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Krajina A, Chrobok V. Radiological diagnosis and management of epistaxis. Cardiovasc Intervent Radiol. 2014;37(1):26–36.CrossRefPubMedGoogle Scholar
  19. 19.
    Reyre A, Michel J, Santini L, et al. Epistaxis: the role of arterial embolization. Diagn Interv Imaging. 2015;96(7–8):757–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Fiorella D, Albuquerque FC, Han P, McDougall CG. Strategies for the management of intraprocedural thromboembolic complications with abciximab (ReoPro). Neurosurgery. 2004;54(5):1089–97. Discussion 1097–1088.CrossRefPubMedGoogle Scholar
  21. 21.
    Bruening R, Mueller-Schunk S, Morhard D, et al. Intraprocedural thrombus formation during coil placement in ruptured intracranial aneurysms: treatment with systemic application of the glycoprotein IIb/IIIa antagonist tirofiban. AJNR Am J Neuroradiol. 2006;27(6):1326–31.PubMedGoogle Scholar
  22. 22.
    Brinjikji W, McDonald JS, Kallmes DF, Cloft HJ. Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms. Stroke. 2013;44(5):1343–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Adeeb N, Griessenauer CJ, Moore JM, et al. Ischemic stroke after treatment of intraprocedural thrombosis during stent-assisted coiling and flow diversion. Stroke. 2017;48(4):1098–100.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Raghav Gupta
    • 1
  • Aakash M. Shah
    • 1
  • Fawaz Al-Mufti
    • 2
  • Chirag D. Gandhi
    • 3
    Email author
  1. 1.Rutgers University- NJ Medical SchoolNewarkUSA
  2. 2.Rutgers University- Robert Wood Johnson Medical SchoolNew BrunswickUSA
  3. 3.Westchester Medical Center/New York Medical CollegeValhallaUSA

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