Coil Surgery Helps Uncontrollable Epistaxis
Last Updated: 2010-05-27 17:16:54 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A small study suggests that placement of platinum fibered coils in the distal internal maxillary artery may put a stop to nosebleeds that won't stop any other way.
The procedure - in which the coils are implanted via arteries in the leg - isn't for everyone. For most patients, of course, home remedies such as pressure and tissues, work just fine, and if not, packing the nasal passages with gauze or else cauterization will solve the problem.
But the author of the study told Reuters Health that in about 1% of the population - generally older patients taking anticoagulants - uncontrollable nosebleeds are severe enough to make this procedure appropriate.
The study, published online today in the Journal of NeuroInterventional Surgery, tracked 20 patients (mean age, 63 years) who received the coil treatment. Dr. Walter Lesley, lead author of the study and director of neuroradiology at the Scott & White Clinic in Temple, Texas, and colleagues report that "95% of the cohort remained free of recurrent nose bleeding requiring medical or surgical intervention (and) 95% of the patients had no complications while one patient (5%) had transient unilateral facial pain."
One patient had another procedure to control bleeding, while another died of unrelated causes.
"There really isn't a lot of good numerical data on using coils at all for nosebleeds," Dr. Lesley told Reuters Health. "Our results were encouraging and certainly warrant a larger study comparing (the procedure) head to head with other methods."
Other options for uncontrollable epistaxis include using a catheter to plug an artery with sponge-like particles, rather than coils, and ligation of the internal maxillary artery with a staple-like clip.
The current study did not directly compare different treatments, but the coil method had a lower failure rate and fewer serious complications than what's been reported for other methods. Those complications - which can include stroke and blindness - affected none of the study's participants.
The risks may be different, said Dr. Peter Willems, a neurosurgeon at Leiden University Medical Center in the Netherlands, because the coils don't penetrate as far into the nasal artery as smaller particles. While this could reduce the possibility of some complications, it may make it more difficult to perform repeat surgery on those who need it.
Dr. Richard Orlandi, an otolaryngologist at the University of Utah, believes that each of the procedures is relatively safe, and that the question comes down to cost and availability. Dr. Orlandi and his colleagues published a study in 2005 which found that the cost of a procedure similar, but not identical, to the one tested here was $14,088 per patient, compared to $7,561 for a procedure that clipped the nasal artery.
"Performing this procedure really does require a fair amount of skill by a radiologist," which could be a problem in rural settings, he told Reuters Health.
Dr. Lesley said the platinum-coil based procedure takes about an hour to complete, and patients either go home that day or the next morning - similar to the recovery time for other treatments.
He said the need for such procedures could grow "because of the benefits of new drugs that thin the blood and can cause more bleeding problems."
http://jnis.bmj.com/content/2/2/171.abstract
J NeuroIntervent Surg 2010.
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