Analysis of Bleeding Site to Identify Associated Risk Factors of Intractable Epistaxis

Intractable epistaxis requiring surgical exploration or arterial embolization; Associated comorbidities and locations of the bleeder

OBJECTIVE

This study aimed to determine which comorbidities were associated with intractable epistaxis requiring electrocauterization or embolization, and to identify the location where intractable epistaxis frequently occurred.

METHODS

The patients were divided into two groups: patients with epistaxis successfully controlled in outpatient department (OPD) and those with intractable epistaxis in OPD which was controlled by surgical exploration or arterial embolization (OP/EM). Evaluations of the bleeding locations, related vessels, and patient's comorbidities were conducted.

RESULTS

A total of 41 patients from the OP/EM group and 725 patients from the OPD group were enrolled. The following comorbidities showed elevated risks of the intractable epistaxis (p< 0.05) in multivariate analysis; hypertension (OR 1.089, 95% CI 1.049 - 1.132), dyslipidemia (1.132, 1.041 - 1.232), liver cirrhosis (1.272, 1.152 - 1.406), chronic obstructive pulmonary disease (1.234, 1.078 - 1.412) and asthma (1.205, 1.053 - 1.379). Inferior and middle turbinate were equally the most common location of the intractable bleeding.

CONCLUSION

In patients with epistaxis requiring hemostatic treatments, comorbidities such as hypertension, dyslipidemia, liver diseases, COPD, and asthma were associated with intractable epistaxis. The main bleeding sites of intractable epistaxis were the middle and inferior turbinate.

Relationship between bleeding sites and clinical data: experience of 646 epistaxis cases in 8 years

PURPOSE

This study aims to investigate the bleeding sites and their relationship with clinical characteristics in hospitalized epistaxis patients.

METHODS

We retrospectively reviewed the data of 646 hospitalized epistaxis patients.

RESULTS

The bleeding sites were identified in 395 (61.1%) patients and unidentified in 251 (38.9%). We found that age > 50 years (P = 0.030) and the history of cardiovascular diseases (P = 0.027) were more frequent in patients with unidentified bleeding sites. Among patients with identified sites, inferior meatus (n = 130, 32.9%) was the most common site, followed by the septal surface of the olfactory region (n = 102, 25.8%), nasal septum (n = 80, 20.3%), middle meatus (n = 60, 15.2%), and others (n = 23, 5.8%). After dividing patients into five groups by the area of the bleeding sites, we found significant differences in age (P = 0.026), history of hypertension (P = 0.001), cardiovascular diseases (P = 0.032), and nasal packing (P = 0.011). The logistic regression also revealed that these four factors were predictors for different bleeding sites.

CONCLUSION

The bleeding sites can be identified in most epistaxis patients. Age > 50 years and the history of cardiovascular diseases are more frequent in patients with unidentified bleeding sites. In our patients, the most common bleeding site is inferior meatus, followed by the septal surface of the olfactory region, nasal septum, and middle meatus. Age, histories of hypertension, cardiovascular diseases, and nasal packing are factors associated with the bleeding risks of different bleeding sites. According to the different clinical characteristics of patients, the order of the nasal endoscopic examination should be adjusted to develop their treatment plans.

Acquired unilateral alopecia after arterial infusion chemotherapy in a recurrent nasopharyngeal carcinoma

Background

Intractable nasopharyngeal hemorrhage is a severe complication with high mortality rate in patients with radiation therapy (RT) for nasopharyngeal carcinoma (NPC) that requires emergency treatment. Quite a few of them combine with tumor recurrence. Treatment planning for these patients is extremely difficult for oncologists, and effective treatments are lacking.

Case

A 42‐year‐old man had a history of recurrent NPC that was treated with 2 cycles of chemoradiotherapies from 2017 to 2019. Five months after the second round of chemoradiotherapy, an episode of massive nasal bleeding occurred. As positron emission tomography (PET) scan revealed tumor recurrence in the left wall of nasopharynx, superselective embolization and subsequent intra‐arterial infusion (IA, 4 times of cisplatin 60 mg + fluorouracil 1.0 g) were performed to stop bleeding and achieve tumor control. To date, the disease‐free survival time has been over 1 year. No tumor recurrence or rebleeding is found except for alopecia on the left side.

Conclusions

Interventional radiology is important and effective in the treatment of recurrent NPC for both massive nasal bleeding and tumor control. However, the unique complication of unilateral alopecia should not be ignored.

Refractory epistaxis and Stamm's S-point

PURPOSE OF REVIEW

Ethmoidal arteries are gaining increasing importance as the main source of severe refractory epistaxis. In this direction, Stamm's S-point, a specific bleeding point in the upper nasal septum, around the projection of the axilla of middle turbinate, posterior to the septal body, was recently described. The aim of this review was to present recent data on S-point and its role in severe refractory epistaxis.

RECENT FINDINGS

Due to the hidden location posterior to the septal body, S-point is not easily identified by anterior rhinoscopy. When systematic endoscopic assessment was performed in severe epistaxis to search for the precise bleeding point, S-point was clearly the most identified (23.7-28.3%). Electrocauterization of bleeding point had high success rates (91.5-100%) and decreased the risk of recurrence bleeding.

SUMMARY

Stamm's S-point plays an important role in severe refractory epistaxis, due to its frequency and stability. However, this specific bleeding point could not be easily identified, so systematic endoscopic assessment should be performed. Recent data has shifted the paradigm of the main source of severe epistaxis from the sphenopalatine artery to ethmoidal arteries and presented high success rates for electrocauterization of bleeding points as single treatment of severe epistaxis.