Intractable epistaxis: which arteries are responsible? An angiographic study.

Area of Science:

• Otolaryngology
• Interventional Radiology
• Vascular Anatomy

Background:

• Epistaxis is a common otolaryngologic emergency.
• Management varies based on the bleeding's anatomical origin.
• Identifying the specific artery is crucial for effective treatment.

Purpose of the Study:

• To determine the primary arterial sources of severe epistaxis.
• To correlate specific arteries with severe bleeding episodes.

Main Methods:

• Retrospective review of 55 angiography and embolization procedures.
• Analysis of patient demographics, medical history, and risk factors.
• Assessment of angiographic findings, including contrast extravasation and embolized arteries.

Main Results:

• Active contrast extravasation identified in 20 procedures.
• Sphenopalatine artery (SPA) was the most frequent bleeding source.
• Anterior ethmoidal artery (AEA) and facial artery were also identified; multiple/bilateral bleeds often linked to systemic factors.

Conclusions:

• Understanding the precise bleeding source improves treatment outcomes and reduces failure rates.
• SPA is confirmed as the leading cause of severe epistaxis.
• AEA's significance in non-traumatic cases is highlighted; other arteries are less common causes, often in patients with comorbidities.