Abstract

Background Safety and efficacy outcomes are lacking for embosurgery of the distal internal maxillary artery (IMax) using detachable platinum fibered coils (DPFCs) in patients with uncontrollable epistaxis.

Methods A retrospective analysis was conducted on patients treated October 2006 through May 2009 with a diagnosis of uncontrollable or recurrent epistaxis managed by DPFC. Inclusion criteria included patients with epistaxis complicating open or endoscopic nasal surgery, or patients with the following covariant risk factors: aspirin, clopidogrel, warfarin, ibuprofen or hypertension. Patients were excluded if particulates, liquid glue or non-permanent embolics were used as adjuvants. Medical record review and follow-up for 1 month were performed on all patients to determine treatment results and complications.

Results A cohort of 20 patients meeting enrollment criteria was comprised of 13 men and 7 women with a mean age of 63 years (range 35–85 years). Epistaxis etiologies included recent nasal surgery (N=2) while all patients (N=20) had one or more covariant epistaxis risk factors. 17 patients underwent bilateral IMax embolization. Three patients had unilateral IMax embosurgery in which two patients had a remote history of contralateral IMax open ligation for previous epistaxis. 95% of the cohort remained free of recurrent nose bleeding requiring medical or surgical intervention. 95% of the patients had no complications while one patient (5%) had transient unilateral facial pain. There was no procedure-related death, blindness or stroke. One patient died during follow-up from unrelated causes.

Conclusion DPFC embosurgery is effective and safe in managing uncontrollable epistaxis.