Trans-arterial embolization in maxillofacial intractable potentially life- threatening hemorrhage

Publication date: Available online 3 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dani Noy, Adi Rachmiel, Omri Emodi, Yaakov Amsalem, Yair Israel, Rafael M. Nagler
PurposeAlthough trans-arterial embolization (TAE) of vascular lesions through angiographic catheters, with embolizing agents, has been used for more than 45 years, reports for life-threatening maxillofacial bleeding is relatively rare and not updated. We review treatment modalities, present our experience of the past 21 years and suggest a comprehensive algorithm and guidelines for the use of TAE in the treatment of intractable life-threatening maxillofacial hemorrhage.MethodsWe describe 28 patients treated with TAE in our hospital due to severe bleeding, who did not respond to conservative therapies. Of these, 13 had uncontrolled epistaxis, 9 were oncology patients, 4 post-surgical and 2 trauma patients.ResultsDetails of patients' medical history, the failed conservative therapy administered prior to TAE, imaging results and blood vessels involved are presented, as well as TAE procedures and materials used, outcome and complications. All these are discussed in respect to the available updated literature. All 9 oncological patients (100%) had been treated with chemotherapy prior to the uncontrolled bleeding, 7 of the 9 also had radiotherapy administered to the maxillofacial region. Continuous anticoagulant therapy also seems to predict such bleeding episodes. TAE resolved the bleeding in all 28 cases, rapidly in 90% of cases. Only in 3 oncological cases did continued bleeding require 3- 4 consecutive TAE sessions and the use of various combinations of embolizing agents.ConclusionsOur reported high rate of success may be the result of careful techniques, appropriate preoperative imaging, highly professional personnel, as well as intraoperative and perioperative treatments.



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