[Severe epistaxis caused by carotid artery rupture]

Area of Science:

• Vascular Surgery
• Neurosurgery
• Otolaryngology

Background:

• Epistaxis can result from internal carotid artery rupture, often due to head trauma.
• Lesions commonly occur along the intra-cavernous internal carotid artery, leading to aneurysms or arteriovenous fistulas.
• Spontaneous carotid artery aneurysm rupture within the sphenoidal sinus is exceptionally rare.

Purpose of the Study:

• To highlight the diagnostic and therapeutic challenges of epistaxis secondary to carotid artery lesions.
• To review current investigation and management strategies for these rare but severe cases.

Main Methods:

• Carotid arteriography is the primary diagnostic tool for identifying carotid lesions.
• Initial management includes bilateral nasal and nasopharyngeal packing.
• Advanced treatments involve carotid artery occlusion, embolization, or balloon probe placement.

Main Results:

• Carotid arteriography is essential for detecting carotid artery lesions causing epistaxis.
• Prompt packing facilitates optimal conditions for diagnostic arteriography and treatment planning.
• Endovascular techniques, including balloon embolization, are effective for permanent thrombosis.
• A para-lateral nasal approach to the sphenoidal sinus offers a less invasive surgical option.

Conclusions:

• Severe epistaxis warrants investigation for underlying carotid artery pathology, even with a history of remote trauma.
• A combination of diagnostic arteriography and minimally invasive endovascular or surgical techniques is crucial for successful management.
• Endovascular occlusion with balloons and para-lateral sinus surgery represent effective, less invasive treatment modalities.