Management of severe and/or refractory epistaxis

Area of Science:

• Otolaryngology
• Interventional Radiology
• Vascular Surgery

Background:

• Severe and refractory epistaxis necessitates hospital admission and presents significant management challenges.
• Treatment options range from conservative measures to invasive procedures like arterial ligation and embolization.
• Comparing the efficacy and safety of different treatment modalities is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the treatment outcomes for severe and/or refractory epistaxis requiring hospitalization.
• To compare the effectiveness and complication rates of arterial ligation versus embolization in epistaxis management.

Main Methods:

• Prospective study including 63 patients admitted for severe/refractory epistaxis between August 2014 and December 2016.
• Patients were treated with conservative measures (tamponade), embolization, or endoscopic ligation.
• Outcomes, including treatment success, hospital stay, and complications, were analyzed.

Main Results:

• Conservative treatment with tamponade was successful in 75% of cases.
• Embolization was used in 17% and endoscopic ligation in 8% of patients.
• Endoscopic ligation was associated with a shorter hospital stay (6 days vs. 9 days for embolization) and no observed complications, unlike one hemispheric stroke post-embolization.

Conclusions:

• Conventional tamponade effectively manages most severe epistaxis cases.
• Endoscopic ligation demonstrates a reduced hospital stay and a favorable safety profile.
• A multidisciplinary approach involving interventional radiologists and experienced surgeons is essential for selecting optimal, individualized treatments and minimizing complications.