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Nosebleeds:
Nosebleeds (epistaxis) are very common; up 50-60% of people suffer from at
least one episode in their lifetime and as many as 6% may need medical
treatment. The type of nosebleed that commonly occurs in children (anterior)
is rarely of major consequence. Nosebleeds in adults often arise from the
back of the nose (posterior) and can be life-threatening.
How are Nosebleeds treated?
Medical treatment begins with local pressure and nasal spraying of
decongestants (which cause the blood vessels to constrict). Nasal packing
(and blood transfusion) may be needed if the bleeding does not stop. If the
bleeding still does not stop, then the physician may need to cauterize the
vessel if he can identify the site of bleeding by examination. If the
bleeding site cannot be found or does not respond to these treatments, or if
the bleeding is too severe, then a procedure to block off the bleeding
vessels (embolization) may be needed. A catheter is inserted into an artery
(usually at the groin, similar to an angiogram) and is moved into the
vessels supplying the nose and material is injected to plug up the bleeding
vessel, allowing it to clot and heal.
What is embolization?
Embolization is an endovascular technique, (performed from within the blood
vessels) to block vessels of the nose and face. Embolization is performed
using catheters and angiographic techniques similar to those discussed
above. For the embolization procedure, a very tiny catheter is threaded from
the groin directly into the nose and face. Under X-ray guidance, material is
injected through the catheter to temporarily block and close off the vessels
to portions of the nose and face. Materials used might include particles and
small platinum coils.
Who performs endovascular embolization procedures?
Endovascular treatment is a relatively new type of treatment requiring
specialized training. Most physicians who perform endovascular embolization
are neuroradiologists or neurosurgeons who have received several years of
additional training in navigating inside the brain blood vessels to treat a
variety of blood vessel disorders.
What do I need to know before having an embolization?
The patient should not eat or drink anything after midnight on the night
before the procedure. This is very important in that any food in the stomach
will make the patient nauseated during the procedure and may cause vomiting
with severe consequences. Patients should take their normal medications the
morning of the procedure with a small amount of water. Embolizations are
usually performed with some sedation. Procedures frequently take 2 to 3
hours and the time necessary is often not predictable before the procedure
begins. The potential complications and risks of the procedure should be
discussed with your doctor.
After the procedure, the patient will need to remain still and avoid bending
the hip where the puncture occurred for at least 6-8 hours. This means lying
flat and is often the portion of the entire experience that is most
uncomfortable. The period of rest is very important since it allows the
small puncture hole in the artery to heal.
Patients usually remain in the hospital for one day following an
embolization procedure, but not always. Nasal packing is usually removed the
next day by the patient’s ENT surgeon.
For more information go to: www.asitn.org
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