Transarterial embolization of Intractable nasal and oropharyngeal hemorrhage using liquid embolic agents

Seth B. Hayes, Jeremiah N. Johnson, Zachary Most, Mohamed Elhammady, Dileep R Yavagal, Mohammad Ali Aziz-Sultan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction Intractable hemorrhage of the nasal or oropharyngeal cavities can be life threatening, and endovascular embolization is one of the few effective treatments for severe recurrent bleeds. Traditionally, embolic particles have been used for transarterial embolization. Objective: To investigate the safety and efficacy of a less commonly performed treatment-namely, feeding artery occlusion with liquid embolic agents. Methods: We retrospectively reviewed our neurointerventional database for patients who had undergone transarterial embolization for intractable nasal and oropharyngeal hemorrhage with Onyx, N-butyl-2 cyanoacrylate (n-BCA) glue, or both, at our institution over a 5-year period from 2008 to 2013. Results: Forty-six patients who underwent a total of 51 procedures met the inclusion criteria. Causes of hemorrhage included neoplasm n=35 (68.6%), trauma n=12 (23.5%), and idiopathic n=4 (7.9%). The bleeding was oropharyngeal in 66.7%, nasal in 29.4%, and 3.9% originated from both sites. Embolic agents used were n-BCA in 26 cases (51.0%), Onyx in 22 cases (43.1%), and both agents in three cases (5.9%). Mean total procedural time was 93.1 min (range 34-323 min), and mean fluoroscopy time was 39.1 min (10-121 min). Mean follow-up time was 7.4 months (0.25-36 months). Five of the 46 patients (10.9%) required re-embolization and one (2.0%) rebled during the same hospital stay. One periprocedural cardiovascular adverse event occurred that was unrelated to the embolic agent used, but no other complications were seen. Conclusions: Transarterial embolization with n-BCA or Onyx is a safe and effective treatment for patients with intractable nasal and oropharyngeal hemorrhage. Further prospective studies are warranted to confirm these findings.

Original languageEnglish (US)
Pages (from-to)537-541
Number of pages5
JournalJournal of NeuroInterventional Surgery
Volume7
Issue number7
DOIs
StatePublished - Jul 1 2015

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Nose
Enbucrilate
Hemorrhage
Fluoroscopy
Adhesives
Length of Stay
Therapeutics
Arteries
Databases
Prospective Studies
Safety
Wounds and Injuries
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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Transarterial embolization of Intractable nasal and oropharyngeal hemorrhage using liquid embolic agents. / Hayes, Seth B.; Johnson, Jeremiah N.; Most, Zachary; Elhammady, Mohamed; Yavagal, Dileep R; Aziz-Sultan, Mohammad Ali.

In: Journal of NeuroInterventional Surgery, Vol. 7, No. 7, 01.07.2015, p. 537-541.

Research output: Contribution to journalArticle

Hayes, Seth B. ; Johnson, Jeremiah N. ; Most, Zachary ; Elhammady, Mohamed ; Yavagal, Dileep R ; Aziz-Sultan, Mohammad Ali. / Transarterial embolization of Intractable nasal and oropharyngeal hemorrhage using liquid embolic agents. In: Journal of NeuroInterventional Surgery. 2015 ; Vol. 7, No. 7. pp. 537-541.
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abstract = "Introduction Intractable hemorrhage of the nasal or oropharyngeal cavities can be life threatening, and endovascular embolization is one of the few effective treatments for severe recurrent bleeds. Traditionally, embolic particles have been used for transarterial embolization. Objective: To investigate the safety and efficacy of a less commonly performed treatment-namely, feeding artery occlusion with liquid embolic agents. Methods: We retrospectively reviewed our neurointerventional database for patients who had undergone transarterial embolization for intractable nasal and oropharyngeal hemorrhage with Onyx, N-butyl-2 cyanoacrylate (n-BCA) glue, or both, at our institution over a 5-year period from 2008 to 2013. Results: Forty-six patients who underwent a total of 51 procedures met the inclusion criteria. Causes of hemorrhage included neoplasm n=35 (68.6{\%}), trauma n=12 (23.5{\%}), and idiopathic n=4 (7.9{\%}). The bleeding was oropharyngeal in 66.7{\%}, nasal in 29.4{\%}, and 3.9{\%} originated from both sites. Embolic agents used were n-BCA in 26 cases (51.0{\%}), Onyx in 22 cases (43.1{\%}), and both agents in three cases (5.9{\%}). Mean total procedural time was 93.1 min (range 34-323 min), and mean fluoroscopy time was 39.1 min (10-121 min). Mean follow-up time was 7.4 months (0.25-36 months). Five of the 46 patients (10.9{\%}) required re-embolization and one (2.0{\%}) rebled during the same hospital stay. One periprocedural cardiovascular adverse event occurred that was unrelated to the embolic agent used, but no other complications were seen. Conclusions: Transarterial embolization with n-BCA or Onyx is a safe and effective treatment for patients with intractable nasal and oropharyngeal hemorrhage. Further prospective studies are warranted to confirm these findings.",
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T1 - Transarterial embolization of Intractable nasal and oropharyngeal hemorrhage using liquid embolic agents

AU - Hayes, Seth B.

AU - Johnson, Jeremiah N.

AU - Most, Zachary

AU - Elhammady, Mohamed

AU - Yavagal, Dileep R

AU - Aziz-Sultan, Mohammad Ali

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Introduction Intractable hemorrhage of the nasal or oropharyngeal cavities can be life threatening, and endovascular embolization is one of the few effective treatments for severe recurrent bleeds. Traditionally, embolic particles have been used for transarterial embolization. Objective: To investigate the safety and efficacy of a less commonly performed treatment-namely, feeding artery occlusion with liquid embolic agents. Methods: We retrospectively reviewed our neurointerventional database for patients who had undergone transarterial embolization for intractable nasal and oropharyngeal hemorrhage with Onyx, N-butyl-2 cyanoacrylate (n-BCA) glue, or both, at our institution over a 5-year period from 2008 to 2013. Results: Forty-six patients who underwent a total of 51 procedures met the inclusion criteria. Causes of hemorrhage included neoplasm n=35 (68.6%), trauma n=12 (23.5%), and idiopathic n=4 (7.9%). The bleeding was oropharyngeal in 66.7%, nasal in 29.4%, and 3.9% originated from both sites. Embolic agents used were n-BCA in 26 cases (51.0%), Onyx in 22 cases (43.1%), and both agents in three cases (5.9%). Mean total procedural time was 93.1 min (range 34-323 min), and mean fluoroscopy time was 39.1 min (10-121 min). Mean follow-up time was 7.4 months (0.25-36 months). Five of the 46 patients (10.9%) required re-embolization and one (2.0%) rebled during the same hospital stay. One periprocedural cardiovascular adverse event occurred that was unrelated to the embolic agent used, but no other complications were seen. Conclusions: Transarterial embolization with n-BCA or Onyx is a safe and effective treatment for patients with intractable nasal and oropharyngeal hemorrhage. Further prospective studies are warranted to confirm these findings.

AB - Introduction Intractable hemorrhage of the nasal or oropharyngeal cavities can be life threatening, and endovascular embolization is one of the few effective treatments for severe recurrent bleeds. Traditionally, embolic particles have been used for transarterial embolization. Objective: To investigate the safety and efficacy of a less commonly performed treatment-namely, feeding artery occlusion with liquid embolic agents. Methods: We retrospectively reviewed our neurointerventional database for patients who had undergone transarterial embolization for intractable nasal and oropharyngeal hemorrhage with Onyx, N-butyl-2 cyanoacrylate (n-BCA) glue, or both, at our institution over a 5-year period from 2008 to 2013. Results: Forty-six patients who underwent a total of 51 procedures met the inclusion criteria. Causes of hemorrhage included neoplasm n=35 (68.6%), trauma n=12 (23.5%), and idiopathic n=4 (7.9%). The bleeding was oropharyngeal in 66.7%, nasal in 29.4%, and 3.9% originated from both sites. Embolic agents used were n-BCA in 26 cases (51.0%), Onyx in 22 cases (43.1%), and both agents in three cases (5.9%). Mean total procedural time was 93.1 min (range 34-323 min), and mean fluoroscopy time was 39.1 min (10-121 min). Mean follow-up time was 7.4 months (0.25-36 months). Five of the 46 patients (10.9%) required re-embolization and one (2.0%) rebled during the same hospital stay. One periprocedural cardiovascular adverse event occurred that was unrelated to the embolic agent used, but no other complications were seen. Conclusions: Transarterial embolization with n-BCA or Onyx is a safe and effective treatment for patients with intractable nasal and oropharyngeal hemorrhage. Further prospective studies are warranted to confirm these findings.

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