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Intractable epistaxis: which arteries are responsible? An angiographic study

Purpose Epistaxis constitutes a significant proportion of the Otolaryngologist’s emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the c...

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Bibliographic Details
Published in:Surgical and radiologic anatomy (English ed.) 2017-11, Vol.39 (11), p.1203-1207
Main Authors: de Bonnecaze, Guillaume, Gallois, Y., Chaynes, P., Bonneville, F., Dupret-Bories, A., Chantalat, E., Serrano, E.
Format: Article
Language:English
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Summary:Purpose Epistaxis constitutes a significant proportion of the Otolaryngologist’s emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis. Methods Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery. Results Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoïdal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors. Conclusions A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.
ISSN:0930-1038
1279-8517
DOI:10.1007/s00276-017-1856-5