Mallinckrodt Institute of Radiology, Interventional Neuroradiology, Washington University School of Medicine, 660 S. Euclid Avenue, St Louis, MO 63110, USA.
J Vasc Interv Radiol. 2013 Feb;24(2):234-9. doi: 10.1016/j.jvir.2012.10.001. Epub 2012 Nov 30.
To determine the safety and efficacy of internal maxillary artery (IMA) and facial artery polyvinyl alcohol (PVA) embolization for treatment of refractory idiopathic epistaxis.
From 1998-2011, 84 patients were referred for endovascular treatment of intractable idiopathic epistaxis. PVA (range, 180-300 μM) particles were used in all cases. One case required microcoils to prevent nontarget embolization. Medical records were reviewed for early recurrences and complications, which were correlated with the number of vessels receiving embolization using the Mantel-Haenszel χ(2)test for linear association; P<.05 was accepted for significance.
Vessels chosen for embolization were unilateral IMA in 8 patients, bilateral IMAs in 35 patients, bilateral IMAs with one facial artery in 32 patients, and bilateral IMAs and bilateral facial arteries in 9 patients. Early (<30 d) rebleeding requiring therapy occurred in nine patients (11%). Minor complications occurred in 22 patients (26%) and included mild facial or jaw pain, facial edema, headache, and transient ischemic attack. There was one major complication that consisted of facial skin sloughing and mild lip ulceration in a patient who had embolization of both IMAs and both facial arteries. A linear association was found when the number of vessels receiving embolization was correlated with both the rates of early recurrence (inversely, P = .04) and minor complications (P = .004).
An initial treatment strategy involving embolization of bilateral IMAs with or without embolization of facial arteries for refractory idiopathic epistaxis is safe and effective. Additional facial artery embolization reduces the risk of early recurrence but increases the risk of minor complications.
确定内上颌动脉（IMA）和面部动脉聚乙烯醇（PVA）栓塞治疗难治性特发性鼻出血的安全性和有效性。
1998 年至 2011 年，84 例患者因难治性特发性鼻出血接受血管内治疗。所有病例均使用 PVA（范围 180-300 μM）颗粒。1 例需要微线圈以防止非目标栓塞。回顾病历以了解早期复发和并发症，并使用 Mantel-Haenszel χ²检验进行线性关联，以评估栓塞血管数量与早期复发和并发症的相关性；P<.05 为有统计学意义。
栓塞的血管选择为单侧 IMA 8 例，双侧 IMA 35 例，双侧 IMA 加一侧面部动脉 32 例，双侧 IMA 和双侧面部动脉 9 例。9 例（11%）患者出现早期（<30d）需治疗的再出血。22 例（26%）患者出现轻微并发症，包括轻度面部或颌部疼痛、面部水肿、头痛和短暂性脑缺血发作。1 例严重并发症为双侧 IMA 和双侧面部动脉栓塞的患者出现面部皮肤坏死和轻度唇溃疡。栓塞血管数量与早期复发率（负相关，P =.04）和轻微并发症（P =.004）呈线性相关。
对于难治性特发性鼻出血，最初的治疗策略是栓塞双侧 IMA 或联合栓塞面部动脉，安全有效。增加面部动脉栓塞可降低早期复发的风险，但增加轻微并发症的风险。
