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  • Transarterial Embolization of Intractable Nasal and Oropharyngeal Hemorrhage using Liquid Embolic Agents

    Final Number:
    1053

    Authors:
    Jeremiah Nicholas Johnson MD; Seth B Hayes MD; Mohamed Samy Elhammady MD; Dileep Yavagal MD; Mohammad Ali Aziz-Sultan MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Intractable hemorrhage of the oral or nasopharyngeal cavity can be life threatening and endovascular embolization is one of the few effective treatment options for severe recurrent bleeds. Traditionally, embolic particles have been used for transarterial embolization. We investigate the safety and efficacy of a less commonly performed treatment method: feeding artery occlusion with liquid embolic agents.

    Methods: We retrospectively reviewed our Neurointerventional database for patients who underwent trans-arterial embolization for intractable oral and nasopharyngeal hemorrhage with either Onyx, n-BCA glue or both performed at our institution over a 5-year period from 2008-2013.

    Results: Forty-six patients who underwent a total of 51 procedures met inclusion criteria. Hemorrhage etiologies included: neoplasm n=35 (68.6%), trauma n=12 (23.5%), and idiopathic n=4 (7.9%). The bleeding was oropharyngeal in 66.7%, 29.4% were from the nasopharynx, and 3.9% originated from both sites. Embolic agents utilized were n-BCA in 26 patients (51.0%), Onyx in 22 patients (43.1%), and both agents in 3 patients (5.9%). Mean total procedural time was 93.1 minutes (34–323 minutes), and mean fluoroscopy time was 39.1 minutes (10– 21 minutes). Mean follow-up time was 7.4 months (0.25–36 months). Five (10.9%) patients required re-embolization and 1 (2.0%) re-bled during the same hospital stay. There was 1 periprocedural cardiovascular adverse event that was unrelated to the embolic agent used but no other complications.

    Conclusions: Trans-arterial embolization with n-BCA or Onyx is a safe and effective treatment option for patients with intractable nasal and oropharyngeal hemorrhage. Further prospective studies are warranted to confirm these findings.

    Patient Care: Introducing evidence for the use of liquid embolic agents in the treatment of intractable nasopharyngeal and oropharyngeal hemorrhage.

    Learning Objectives: 1) understand the indications for treating oral, nasal and pharyngeal hemorrhage with trans-arterial embolization. 2) Identify the different embolic agent classes available to treat intractable oral and nasal hemorrhage. 3) Discuss the risk and benefit profiles of liquid embolic agents and particle embolic agents in this setting and summarize the evidence supporting each strategy.

    References:

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