About Epistaxis Embolization
While epistaxis can usually be well controlled with nasal packing and cauterization, refractory cases are good candidates for embolization.
Generally, angiography in cases of epistaxis is normal (does not show a site of extravasation), and so empiric embolization is performed. The ipsillateral facial artery and both internal maxillary arteries are occluded with small particulate material, usually PVA (polyvinyl alcohol) and gelfoam. The contrallateral facial artery is left open so as to prevent nasal necrosis.
Treatment success is in the 90-95% range.
Failures that do occur are often the result of prominent nasal supply from ethmoidal branches descending off the ophthalmic artery which, due to its origin off the internal carotid artery, is not amenable to safe embolization.
Less common causes of epistaxis, such as post-traumatic, iatrogenic or tumoral, are also amenable to more targeted arterial occlusion.