Transcatheter Arterial Embolization for Intractable Epistaxis Secondary to Gunshot Wounds

Purpose To evaluate the efficacy of transcatheter arterial embo-lization for intractable epistaxis secondary to gunshot wounds. Materials and Methods Seven patients with intractable epistaxis secondary to penetrating trauma (gunshot wounds) were studied with angiography and subsequently underwent embolization with particles (polyvinyl alcohol, gelatin sponge) and/or microcoils. Clinical follow-up included standard hemodynamic monitoring, serial hematocrit determinations, and clinical observation for recurrent bleeding. Results Diagnostic angiography demonstrated evidence of acute arterial injury in all patients. All patients subsequently underwent embolization to complete angiographic stasis. Two patients had persistent bleeding following embolization. One of these patients required maintenance of his nasal packing for 7 days after emboli-zation; no blood products were required during this time. The sec-ond patient's bleeding resolved following correction of his coagu-lopathy. No complications occurred in any of the patients. Conclusions Transcatheter arterial embolization for epistaxis secondary to gunshot wounds is efficacious in the acute setting when conservative management fails.