Patients with epistaxis, commonly called nose bleeds, that are persistent enough to categorize themselves as life threatening nose bleeds may also benefit from embolization. Few patients may need a second treatment. Not all people are candidates or will benefit from treatment; however at times these patients can be treated by surgical intervention from ENT (ear, nose and throat) surgeons. For patients with severe nose bleeds, our Interventional Neuroradiology staff physicians are usually notified by the ENT service. Often patients have already received nasal packing, or a balloon which may decrease bleeding.
The patient will then be medically evaluated by the interventional neuroradiology staff. Sometimes a blood bank sample needs to be sent and the patient needs to be evaluated by CTA to exclude neoplasm or abnormal anatomy. If it is appropriate to treat the patient, he or she is brought to the angiography suite and placed under conscious sedation or general anesthesia.
The Embolization Procedure
First a diagnostic cerebral angiogram is performed to assess the vessels of the face and nose. This is done by placing a sheath into the femoral artery of the groin. A catheter is then placed through the sheath and advanced into the neck vessels. Once the diagnostic angiogram is completed, a microcatheter is passed through a guide catheter in the appropriate artery. Branches of this vessel supplying the nasal region are embolized with particles (PVA, Gelfoam, Coils) or other material. The procedure takes one to two hours. Afterward, the patient's leg needs to be kept straight for four to six hours depending on the closure of the initial incision site.