Operating-room polidocanol sclerotherapy for HHT-related epistaxis

PURPOSE: Hereditary haemorrhagic telangiectasia (HHT) is frequently associated with recurrent epistaxis, causing morbidity and impaired quality of life. Data on operating room-based endonasal polidocanol sclerotherapy remain limited. This study aimed to assess the effectiveness, safety, patient acceptance, and procedural feasibility of this approach for HHT-related epistaxis. METHODS: A retrospective observational study was conducted in a tertiary referral centre including 20 adults with HHT treated with endonasal polidocanol sclerotherapy between March 2022 and December 2025. Clinical variables, visceral arteriovenous malformation (AVM) involvement, procedure-related variables, complications, and patient-reported outcomes were analysed. RESULTS: A total of 59 procedures were performed. Mean weekly epistaxis frequency decreased from 8.3 to 2.35 episodes per week (p < 0.001), with a mean relative reduction of 68.1% and an effect size of 1.27. Seventeen patients (85%) met responder criteria, defined as a reduction of at least 50% in weekly epistaxis frequency compared with baseline. Fourteen patients (70%) presented visceral AVM involvement, and 35% had high-burden disease. Severe epistaxis episodes requiring hospital-based care showed a non-significant numerical decrease. Two patients (10%) experienced complications, one requiring hospital admission. Nineteen patients (95%) reported willingness to undergo the procedure again. CONCLUSION: Operating room endonasal polidocanol sclerotherapy was associated with clinically meaningful reduction in epistaxis burden, high patient acceptance, and a favourable safety profile. This approach may represent a valuable option for selected patients with recurrent HHT-related epistaxis requiring structured management beyond an office-based setting.