Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications

Figure 3

Embolization of left facial artery (FA) in a 25-year-old male patient with epistaxis and hereditary hemorrhagic telangiectasia having had a double-sided embolization 5 years ago. (a) Angiogram of the external carotid artery (ECA) shows coils in both SPA/IMA (right and left; white open arrows) after a successful double-sided embolization in 2014. Examination shows an extended collateral network via the facial artery (FA) in 2019. The collateral network consists of cross-connections of the superior labial artery (SLA)/infraorbital artery (IOA, open black arrow) and branches of FA/descending palatine artery (DPA, black arrow). (b) Coil embolization of FA was performed (black arrow). Control angiogram after embolization shows no significant contrast flow in the collateral network and Kiesselbach’s plexus. Also shown is the labial artery (LA).