Journal article
Impact of Vessel Choice on Outcomes of Polyvinyl Alcohol Embolization for Intractable Idiopathic Epistaxis
Journal of vascular and interventional radiology, Vol.24(2), pp.234-239
02/2013
DOI: 10.1016/j.jvir.2012.10.001
PMID: 23200604
Abstract
To determine the safety and efficacy of internal maxillary artery (IMA) and facial artery polyvinyl alcohol (PVA) embolization for treatment of refractory idiopathic epistaxis.
From 1998–2011, 84 patients were referred for endovascular treatment of intractable idiopathic epistaxis. PVA (range, 180–300 μM) particles were used in all cases. One case required microcoils to prevent nontarget embolization. Medical records were reviewed for early recurrences and complications, which were correlated with the number of vessels receiving embolization using the Mantel-Haenszel χ2test for linear association; P<.05 was accepted for significance.
Vessels chosen for embolization were unilateral IMA in 8 patients, bilateral IMAs in 35 patients, bilateral IMAs with one facial artery in 32 patients, and bilateral IMAs and bilateral facial arteries in 9 patients. Early (<30 d) rebleeding requiring therapy occurred in nine patients (11%). Minor complications occurred in 22 patients (26%) and included mild facial or jaw pain, facial edema, headache, and transient ischemic attack. There was one major complication that consisted of facial skin sloughing and mild lip ulceration in a patient who had embolization of both IMAs and both facial arteries. A linear association was found when the number of vessels receiving embolization was correlated with both the rates of early recurrence (inversely, P= .04) and minor complications (P= .004).
An initial treatment strategy involving embolization of bilateral IMAs with or without embolization of facial arteries for refractory idiopathic epistaxis is safe and effective. Additional facial artery embolization reduces the risk of early recurrence but increases the risk of minor complications.
Details
- Title: Subtitle
- Impact of Vessel Choice on Outcomes of Polyvinyl Alcohol Embolization for Intractable Idiopathic Epistaxis
- Creators
- Ravi Gottumukkala - Mallinckrodt Institute of Radiology, Interventional Neuroradiology, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110Yasha Kadkhodayan - Mallinckrodt Institute of Radiology, Interventional Neuroradiology, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110Christopher J Moran - Mallinckrodt Institute of Radiology, Interventional Neuroradiology, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110De Witte T Cross - Mallinckrodt Institute of Radiology, Interventional Neuroradiology, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110Colin P Derdeyn - Mallinckrodt Institute of Radiology, Interventional Neuroradiology, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
- Resource Type
- Journal article
- Publication Details
- Journal of vascular and interventional radiology, Vol.24(2), pp.234-239
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jvir.2012.10.001
- PMID
- 23200604
- ISSN
- 1051-0443
- eISSN
- 1535-7732
- Language
- English
- Date published
- 02/2013
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020501302771
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