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The Role of Angiography and Embolization in the Management of Recurrent Epistaxis

I n this article, we discuss a case of recurrent epistaxis despite previous bilateral anterior ethmoid and internal maxillary artery ligations. Bilateral internal and external carotid arteriography was used to identify a persistently patent right sphenopalatine artery as the source of bleeding; this vessel was embolized with polyvinyl alcohol foam particles. Bleeding stopped immediately, resulting in a rapid uneventful recovery of the patient. The role of angiography and embolization in the management of recurrent epistaxis is discussed. Severe idiopathic epistasis is normally treated with cauterization, nasal packing, or surgical ligation of the ethmoid, distal maxillary, or external carotid arteries. Occasionally recurrent or persistent bleeding occurs despite conventional treatment. This case is presented to illustrate the role of angiography and therapeutic embolization in the management of a patient with recurrent, persistent posterior epistaxis.