Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

Presenting as Intractable EpistaxisObjective: To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. Materials and Methods:For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed.Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery.In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion.All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography.Results: Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies.Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. Conclusion:In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis.Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.pistaxis is a common medical condition.Most cases are due to bleeding from the anterior nasal septum and are easily managed with local measures, such as applying pressure to the nostrils, chemical or electrocautization, topical hemostatic or vasoconstricting agents, cryotherapy, hot water irrigation, or anterior nasal packing together with the management of underlying risk factors such as hypertension and oral anticoagulation (1).However, in about 5% of the cases, the origin of the epistaxis lies in a more posterior part of the nasal cavity; this epistaxis is more severe with a distinct source of bleeding, which is often difficult to localize (2).Historically, the definitive treatment for intractable posterior epistaxis consisted of transantral surgical ligation of the branches of the internal maxillary artery (IMA).The first endovascular treatment of epistaxis was presented as an alternative to surgery by Sokoloff et al. (3) in 1974.Nowadays, endovascular management of refractory epistaxis is in the clinical mainstream and has yielded impressive results.However, quite rarely, life-threatening hemorrhages associated with craniocerebral