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

Table 4

Outcome of patients in a follow-up period of at least 6 months.

In 111 patients, embolization controlled active hemorrhage and no surgery was necessary	90.2%
(i) In 101 patients, a one-sided embolization was sufficient to stop the bleeding
(ii) 2 patients had a rebleeding at the third and fourth days after intervention and needed embolization of contralateral side; embolization of the contralateral site was performed without particles to avoid facial necrosis, since there was only a short interval to the first embolization
(iii) 4 patients had a rebleeding at the 7^thtill 14^thday after intervention and needed embolization of the contralateral side
(iv) 2 patients had a rebleeding after 31 and 32 days after intervention and needed embolization of contralateral side
(v) 1 patient had a rebleeding after 5 months after intervention and needed embolization of the contralateral side
(vi) 1 patient with hereditary hemorrhagic telangiectasia had a successful double-sided embolization in 2014 (rebleeding after 36 days) and a rebleeding in 2019; in 2019, an embolization of the facial artery was performed without particles (Figure 3)
12 patients needed additional surgery	9.7%
(i) 4 patients had surgery at the following day after one-sided embolization due to recurrence of bleeding
(ii) 1 patient had a rebleeding 7 days after one-sided embolization and received surgery
(iii) 3 patients had a rebleeding after 7, 22, and 28 days, respectively, after successful endovascular treatment, and contralateral embolization failed to stop the rebleeding, surgery was performed
(iv) 1 patient had a rebleeding one week after successful embolization; embolization failed due to lack of possibility to catheterize contralateral IMA (technical failure); the patient received surgery
(v) 2 patients with hereditary hemorrhagic telangiectasia had a rebleeding 49 and 97 days, respectively, after a successful embolization; contralateral embolization was not successful in stopping the bleeding; surgery was performed
(vi) 1 patient had a successful embolization of left IMA/SPA and 53 days later had a rebleeding on the left side; an embolization of the left external carotid artery (ECA) was performed due to an atypical accessory artery (Figure 4); 7 days later, a rebleeding occurred and embolization of the right IMA/SPA was performed; due to recurrence of bleeding, surgery was performed