School of Medicine, West Virginia University, Morgantown, WV, USA.
Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
Ann Otol Rhinol Laryngol. 2023 Oct;132(10):1233-1248. doi: 10.1177/00034894221143187. Epub 2022 Dec 29.
Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization.
This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications.
Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation.
Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications.
血管内栓塞已成为治疗难治性鼻出血的有效方法。本系统评价和荟萃分析旨在计算成功率、再出血率和并发症发生率，并确定接受血管内栓塞治疗的患者的病因和并发症。
本系统评价和荟萃分析按照系统评价和荟萃分析首选报告项目（PRISMA）的指南进行。从 Scopus、PubMed、Web of Science 和 Cochrane Central 提取文章，并使用 Rayyan 软件进行系统评价流程过滤。使用随机效应模型来量化成功率、再出血率和并发症发生率。
共纳入 42 项研究，总计 1660 名患者。汇总的成功率为 89%（95%置信区间 86%-92%），再出血率为 19%（95%置信区间 16%-22%）。汇总的轻微并发症发生率为 18%（95%置信区间 11%-27%）。最常见的主要并发症是软组织坏死，其次是中风。最常见的轻微并发症是面部疼痛。没有报告轻微并发症是永久性的。在最初栓塞治疗失败的患者中，42%接受了重复栓塞治疗，34%接受了动脉结扎手术。
血管内栓塞是治疗难治性鼻出血的有效方法。鉴于罕见但严重的主要并发症，应仔细权衡进行栓塞治疗的决策。
