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Luca Remonda, MD; Gerhard Schroth, MD; Marco Caversaccio, MD; Kurt Lädrach, MD, DMD; Karl O. Lövblad, MD; Peter Zbären, MD; Joram Raveh, MD, DMD

Arch Otolaryngol Head Neck Surg. 2000;126:1255-1262.

Objective  Acute and subacute hemorrhage in the head and neck often represent a life-threatening situation. The goal of this study is to evaluate the indications for and contributions of endovascular techniques in the diagnosis and management of such severe cases.

Design  Seventy-two patients with acute or subacute intractable hemorrhage of the head and neck were treated over a period of 5 years: 2 patients had experienced trauma; in 6 cases the cause of bleeding was iatrogenic; and in 2 patients intraosseous arteriovenous malformations were manifested. Fifteen patients had tumors, 9 of whom had prior radiotherapy. Forty-seven patients presented with epistaxis (41 idiopathic and 6 during anticoagulation therapy). The endovascular therapy was performed using polyvinyl alcohol particles, fibered platinum or electrolytically detachable coils (Guglielmi detachable coils; Target Therapeutics, Fremont, Calif), a stent, glue (Ethibloc; Ethicon GmbH, Norderstedt, Germany, and Histoacryl; B. Braun Melsungen AG, Melsungen, Germany), or with a combination of these different embolic materials.

Results  The acute bleeding was successfully controlled in all cases. Fourteen patients (7 with epistaxis, 5 with tumors, and 2 with arteriovenous malformations) had to be embolized more than once before the bleeding could be controlled. The idiopathic, traumatic, iatrogenic, and remaining tumoral cases were treated only once. The long-term morbidity was 1.9%.

Conclusions  Owing to the recent continuous advances in interventional radiologic techniques, it is possible to treat both acute and subacute life-threatening head and neck hemorrhage most efficiently. In many cases the endovascular therapy complements surgery.

From the Divisions of Neuroradiology (Drs Remonda, Schroth, and Lövblad), Otorhinolaryngology–Head and Neck Surgery (Drs Caversaccio and Zbären), and Craniofacial/Skull Base, Facial Plastic and Reconstructive Surgery (Drs Lädrach and Raveh), The University of Bern–Inselspital, Bern, Switzerland.

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