Embolization for Epistaxis

Embolization for Epistaxis | Vascular Neurology of Southern California

During a stroke, when the brain is not receiving adequate oxygen and nutrient supply, every second counts.

Epistaxis, or nosebleed, is a relatively common complaint experienced by the general population. These result when the tissue that lines part of the nose erodes, and blood vessels become exposed and break.

You may have experienced it or know someone, perhaps even a family member, who has. About 60% of people will experience one or more episodes of nosebleeds in their lifetime, with men and women being equally affected.

Depending on the location of the bleeding in the nasal cavity, epistaxis can be divided into two types: anterior or posterior. The anterior type is far more frequent, often self-limiting, and, if needed, is relatively easy to treat. The most common site of bleeding is an area in the anterior septum rich in blood vessels and with thin mucosa known as the Kiesselbach plexus.

Posterior type epistaxis, found at the back of the nose, is rare and more likely to require medical attention. This type of blood flow is usually heavier and more difficult to control. It is frequently associated with airway obstructions and can result in blood entering the lungs, as well as abnormally low blood plasma volume.

What are the Causes of Epistaxis?

  • Trauma
  • Structural abnormalities (septum separating the nose into two sides)
  • Irritation of tissue lining the nasal cavity
  • Tumors
  • Hardening of arteries (arteriosclerosis)
  • High blood pressure
  • Vitamin K deficiency
  • Inflammatory diseases
  • Blood or blood vessel disorders (hereditary hemorrhagic telangiectasia)
graphic of brain

Patients with persistent or recurrent epistaxis are typically good candidates for endovascular intervention. The condition may become a genuine medical or surgical emergency because of the amount of blood, repeated episodes, or patient’s medical vulnerability (such as those with coronary artery disease).

If you or a loved one experience troubling, recurring episodes of nosebleeds (epistaxis), you should not hesitate to contact Dr. M. Asif Taqi and his team to schedule an appointment in Thousand Oaks or West Hills, CA.

As a triple-board certified neurointerventionalist, Dr. Taqi has extensive training and advanced expertise in treating severe cases of epistaxis. His first-hand understanding of the challenges presented by the diagnosis of this condition has earned him the reputation of being among California’s most respected surgeons.

Epistaxis (Nosebleed) Explained

Most nosebleed episodes are self-limited, which means the bleeding will stop without medical assistance. Epistaxis can, however, be life-threatening. This is especially true in elderly patients and in others with diseases or conditions that typically occur together with nosebleeds.

In general, blood will flow from a single nostril during epistaxis. However, when the nosebleed is particularly heavy, it may also spill into the second nostril. It may also run down the throat and into the stomach resulting in the patient spitting up or vomiting blood. On rare occasions where blood loss is substantial, the patient may become light-headed, dizzy, and could even faint.

Generally, nose bleeds are easy to observe. When they are especially severe or frequently recur, we recommend that you see a doctor. Laboratory tests will help the doctor evaluate any underlying medical conditions that may be leading to severe bleeding.

What Are the Options for Treating Epistaxis?

Most minor nosebleeds can be self-treated by directly applying manual pressure to the nostrils and squeezing them between the fingers for up to 30 minutes.

For more severe occurrences, you should discuss other options with your doctor, which are summarized below.

Cauterization: If the blood vessels causing the bleeding can be easily seen and accessed, the doctor can seal them with a technique called cauterization.

Medications: Where bleeding is severe and recurring, medications are available to control the pain and to treat conditions causing the bleeds. These conditions include vitamin K deficiency and high blood pressure. Antibiotics may be necessary to prevent infection.

Surgery: Where severe nosebleeds occur frequently, surgery such as arterial ligation may be an option.

Embolization: Some patients consider embolization, a minimally invasive procedure that requires local anesthesia only. Embolization looks to block the bleeding vessels effectively.

Your surgeon will also perform an angiography (using contrast material and X-ray imaging) to monitor the blood flow through the arteries both before and after the procedure.

What Exactly is Epistaxis Embolization?

Epistaxis embolization is a minimally invasive procedure in which the surgeon deliberately blocks blood vessels to stop the nosebleed.

The procedure aims to stop the blood flowing into the vessels, which causes the nosebleed in the first place. It also prevents blood from flowing into the area around the affected vessels.

By using X-ray imaging for guidance, a catheter (a long, thin tube) is guided up the femoral artery in the groin to the blood vessel causing the nosebleed. Once in position, an embolizing agent in the form of either small resin particles (known as microparticles), small metal spirals (known as microcoils), a glue-like substance, or some other material, is injected to block the artery and stop the bleeding.

Minor risks include bruising in the groin, but more significant risks include the possibility of the microparticles or the microcoils moving to other areas of your body or blocking other artery branches.

The main reason to treat severe nosebleeds with epistaxis embolization is to minimize the risk of the patient breathing in blood, which could cause drowning. Also, this treatment approach is much less invasive, costs less, and usually does not require general anesthesia.

What Do I Need to Keep in Mind After Epistaxis Embolization?

To aid in their recovery from the embolization, patients need to be sure to do the following:

  • Use helmets or facepieces during strenuous activities for protection from direct trauma from sports activities.
  • Avoid hot and spicy foods
  • Drink plenty of fluids.
  • Avoid hot and dry environments. The effects of these can be eased by using humidifiers, thermostatic controls, saline spray, and antibiotic ointment on the Kiesselbach area.
  • Avoid digital trauma. Especially in children, nose picking is difficult to deter and should probably be considered inevitable. Keeping the child’s nails well-trimmed may be helpful.
  • Avoid nose blowing and excessive sneezing. Instruct patients to sneeze gently with the mouth open.
  • Avoid inappropriate or careless use of drugs. Consider drug education relating to the use or accidental ingestion of medications such as aspirin, or drug abuse in adolescents.

Be sure to arrange for a follow-up visit with your doctor. He will help you implement long-term monitoring and help you avoid recurring nosebleeds.

Why Choose Dr. Taqi For Your Epistaxis Embolization?

If you or your loved one have been diagnosed with epistaxis, seek treatment from Southern California’s leading neurointerventionalist, Dr. M. Asif Taqi. Contact him or call (805) 242-4884 to schedule your appointment today.