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An D, Li Z, Zhao X, Liu J. Anatomical variation of the posterior septal artery leads to refractory epistaxis. World J Otorhinolaryngol Head Neck Surg 2024; 10:241-243. [PMID: 39233866 PMCID: PMC11369799 DOI: 10.1002/wjo2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 09/06/2024] Open
Abstract
Purpose To report a rare variant of the posterior septal artery (PSA), which supplies blood to the posterior mucosa of the contralateral nasal septum. Case report A 31-year-old female patient underwent suture removal 14 days after septoplasty and developed left-sided epistaxis 6 h after suture removal. To safely and effectively relieve the patient from epistaxis, the cauterization of the left PSA was performed under general anesthesia. However, 24 h after the first surgical hemostasis, the patient experienced epistaxis again in the right nasal cavity. We have reviewed the patient's sinus computed tomography again and found a rare variant of PSA, which is the right-sided PSA passing through a bony canal in the left-sided nasal septum. Discussion The variant of PSA well explained the failure of the first hemostatic surgery. Therefore, we again performed a cauterization of the right-sided PSA, after which the patient recovered and no further epistaxis occurred. Conclusion When cauterization of PSA is used to manage posterior epistaxis, it is necessary to pay attention to the possible variation in PSA.
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Affiliation(s)
- Dong‐Jiao An
- Department of Anaesthesiology, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Zu‐Fei Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Xiao‐Chang Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Jin‐Feng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
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Koskinas I, Terzis T, Georgalas C, Chatzikas G, Moireas G, Chrysovergis A, Triaridis S, Constantinidis J, Karkos P. Posterior epistaxis management: review of the literature and proposed guidelines of the hellenic rhinological-facial plastic surgery society. Eur Arch Otorhinolaryngol 2024; 281:1613-1627. [PMID: 38032485 PMCID: PMC10943169 DOI: 10.1007/s00405-023-08310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Posterior epistaxis is a common emergency in ENT practice varying in severity and treatment. Many management guidelines have been proposed, all of which are a product of retrospective analyses due to the nature of this pathology, as large-scale double-blind studies are impossible-even unethical-to conduct. The purpose of this review is to perform a thorough analysis and comparison of every treatment plan available and establish guidelines for the best possible outcome in accordance to every parameter studied. Given the extensive heterogeneity of information and the multitude of studies on this topic, along with the comparison of various treatment options, we opted for a literature review as our research approach. METHODS A review of the literature was performed using PubMed Database and search terms included "posterior epistaxis", "treatment", "management", "guidelines", "algorithm" "nasal packing", "posterior packing", "surgery", "SPA ligation", "embolization", "risk factors" or a combination of the above. RESULTS Initial patients' assessment invariably results in most cases in posterior packing. There seems to be a superiority in recent literature of early surgery over nasal packing as a definitive treatment. Embolization is usually used after surgery failure, except for specific occasions. CONCLUSION Despite the vast heterogeneity of information, there seems to be a need for re-evaluation of the well-established treatment plans according to more recent studies.
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Affiliation(s)
- Ioannis Koskinas
- 1st Academic Otolaryngology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 Str, 546 21, Thessaloniki, Greece.
| | - Timoleon Terzis
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
| | - Christos Georgalas
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
| | - Georgios Chatzikas
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
| | - Georgios Moireas
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
| | | | - Stefanos Triaridis
- 1st Academic Otolaryngology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 Str, 546 21, Thessaloniki, Greece
| | - Jannis Constantinidis
- 1st Academic Otolaryngology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 Str, 546 21, Thessaloniki, Greece
| | - Petros Karkos
- 1st Academic Otolaryngology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Kiriakidi 1 Str, 546 21, Thessaloniki, Greece
- Hellenic Rhinological-Facial Plastic Surgery Society, Thessaloniki, Greece
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El Naamani K, Morse C, Ghanem M, Barbera J, Amllay A, Severance G, Ruiz R, Sweid A, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH, Nyquist GG, Tjoumakaris S. Endovascular Embolization for Epistaxis: A Single Center Experience and Meta-Analysis. J Clin Med 2023; 12:6958. [PMID: 38002574 PMCID: PMC10672438 DOI: 10.3390/jcm12226958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The optimal treatment for intractable epistaxis is still controversial. Various studies have demonstrated high success rates and low complication rates for endovascular embolization. Herein, the authors report an institutional experience and meta-analysis in terms of efficacy and safety of endovascular embolization of intractable epistaxis. This was a retrospective observational study of 35 patients with epistaxis who underwent 40 embolization procedures between 2010 and 2023. The primary outcome was immediate success defined by immediate cessation of epistaxis at the end of the procedure. Immediate success was achieved in most of the procedures (39, 97.5%). During follow-up, three (7.5%) patients experienced a rebleed. Forty-one studies from 3595 articles were identified for inclusion in the meta-analysis and comprised 1632 patients. The mean pooled age was 57.5 years (95% CI: 57.2-57.8) and most patients were males (mean: 70.4, 95% CI: 69.8-71.0). Immediate success was achieved at a pooled mean of 90.9% (95% CI: 90.4-91.4) and rebleeding was observed at a pooled mean of 17% (95% CI: 16.5-17.5). In conclusion, endovascular embolization proved to be both safe and effective in treating intractable epistaxis carrying a low risk of post-operative stroke.
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Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Charles Morse
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Marc Ghanem
- School of Medicine, Lebansese American University, Beirut 1102-2801, Lebanon;
| | - Julie Barbera
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Abdelaziz Amllay
- School of Medicine, Hassan II University, Casablanca 8118, Morocco;
| | - Grace Severance
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Ramon Ruiz
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Michael R. Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Nabeel A. Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Robert H. Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Gurston G. Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA;
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
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Bonnici M, Orabi NA, Gannon M, Williams N, Stokes CM, Ramadan HH, Turner MT, Makary CA. Complications and Outcomes of Endovascular Embolization for Intractable Epistaxis: A Systematic Review and Meta-analysis. Ann Otol Rhinol Laryngol 2023; 132:1233-1248. [PMID: 36582148 DOI: 10.1177/00034894221143187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization. METHODS This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications. RESULTS Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation. CONCLUSIONS Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications.
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Affiliation(s)
| | - Norman A Orabi
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Michael Gannon
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Nathan Williams
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Cara M Stokes
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Meghan T Turner
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Chadi A Makary
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
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Endovascular embolisation of external carotid artery system haemorrhage in radiated nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2022; 279:5851-5858. [PMID: 35792916 DOI: 10.1007/s00405-022-07491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To review the effectiveness and safety of embolisation in managing haemorrhage from the external carotid artery (ECA) system in radiated nasopharyngeal carcinoma (NPC) patients. METHODS Radiated NPC patients who presented with severe oronasal bleeding and underwent digital subtraction angiography that excluded blowouts from the internal carotid artery from 2011 to 2021 were reviewed. Those who subsequently underwent embolisation of the ECA system were analysed for technical success rate, post-embolisation re-bleeding rate and complications. RESULTS Seventeen embolisations were performed in fifteen patients during the 10-year period. The technical success rate was 100%, however the early haemostatic rate (no re-bleed within 7 days of embolisation) was 70.6% (12/17) and the overall long-term haemostatic rate was 58.8% (10/17). The re-bleed rates of targeted and empiric embolisations were 33.3% (3/9) and 50.0% (4/8), respectively. The re-bleed rates with liquid agents, coils and particles were 0% (0/7), 33.3% (1/3) and 85.7% (6/7), respectively. Amongst the embolisations utilising liquid agents, 71.4% (5/7) were targeted, distal embolisations. All re-bleeds underwent surgical ligation or repeat embolisation; half of them further experienced recurrent bleeding. There were no significant complications with embolisation. CONCLUSION Although embolisation of the ECA system in NPC has a high technical success rate and is safe, re-bleeding appears to be common. Targeted, distal embolisation with liquid embolics appear to have good haemostatic effect. Clinicians should be aware that patients may need repeated procedures to secure haemostasis.
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Yin X, Zhang X, Wang B, Li K, Duan M. Combination of a negative pressure suction device and endoscope can accurately locate the bleeding site of refractory epistaxis. Acta Otolaryngol 2021; 141:929-933. [PMID: 34633896 DOI: 10.1080/00016489.2021.1965652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Selective endoscopic coagulation of a nasal bleeding vessel is an effective means of treating epistaxis. Precisely locating the bleeding site(s) is critical. OBJECTIVE To investigate the utility of combining a negative pressure suction device and endoscope in locating bleeding sites of refractory epistaxis. METHODS A total of 116 patients with refractory epistaxis, who underwent systematic endoscopic exploration under local anesthesia in the absence of identifiable sites of bleeding were randomizely divided into two groups via negative pressure group (NPG) and control group (CG): The negative pressure suction device combined with an endoscope was used to re-explore the epistaxis. Nasal bleeding was induced using this method to help the operator locate the site of epistaxis accurately; the bleeding was then stopped using electrocoagulation with the suction electrode. The CG was treated with endoscopic re-exploration and selective tamponade. RESULTS Compared with the CG, there were statistically significant differences in length of hospital stay, rebleeding, and postoperative pain and complications (all p < .05). CONCLUSION AND SIGNIFICANCE Combining a negative pressure suction device and endoscope was a safe and effective technique for accurately locating bleeding sites in patients with refractory epistaxis.
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Affiliation(s)
- Xinghong Yin
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Xinhai Zhang
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Bo Wang
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Keliang Li
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Maoli Duan
- Division of Ear, Nose and Thoat Disease, Department of Clinical Science, Intervention and Technology karolinska Institutet, Stockholm, Sweden
- Ear Nose and Throat Patient Area, Trauma and Reconstructive Medicine, Karolinska University Hospital, Stockholm, Sweden
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