Treatment of profuse epistaxis in patients irradiated for nasopharyngeal carcinoma

George K.C. Wong, Kin K. Chan, Simon C.H. Yu, Raymond K.Y. Tsang, Wai-sang Poon

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

Background: Profuse epistaxis in patients with nasopharyngeal carcinoma (NPC) previously treated with radiotherapy (RT) can be life threatening. Surgical means to prevent rebleeding may at times be difficult and unsuccessful. We aim to investigate the characteristics of this group of patients and our experience of endovascular embolization technique in the management of epistaxis in this group of patients. Methods: A retrospective review of all nasopharyngeal carcinoma patients presented with profuse epistaxis during follow up after radiotherapy was carried out in a regional neurosurgical centre in Hong Kong. Seventeen patients were included for the analysis within the recent 6-year period. The age of patients was 55.5 ± 8.358 years (mean ± standard deviation). The sex ratio was 5:1 (M:F). Diagnostic catheter angiography was carried out in all 17 patients. Endovascular embolization was carried out in 11 patients with the joint decision of the otolaryngologist and neurointerventionist in charge. Results: Four patients underwent main trunk occlusion for internal carotid pseudoaneurysm. Seven patients underwent embolization of branches of external carotid artery. One patient required another session of external carotid artery embolization 1 month later. There was one inpatient death because of pneumonia and hepatic encephalopathy. With our protocol, there were only two patients (11.7%) with delayed rebleed at 2 and 5 months, respectively. Both patients had advanced diseases and died. Conclusion: In irradiated patients with nasopharyngeal carcinoma presenting with profuse epistaxis, angiography had a high yield of pseudoaneurysm or hypervascularity and these lesions could be safely managed through endovascular embolization.

Original languageEnglish (US)
Pages (from-to)270-274
Number of pages5
JournalANZ journal of surgery
Volume77
Issue number4
DOIs
StatePublished - Apr 1 2007

Fingerprint

Epistaxis
Therapeutics
External Carotid Artery
Nasopharyngeal carcinoma
Angiography
Radiotherapy
Carotid Artery Injuries
Endovascular Procedures
Hepatic Encephalopathy
False Aneurysm
Sex Ratio
Hong Kong
Inpatients

Keywords

  • Embolization
  • Endovascular treatment
  • Epistaxis
  • Nasopharyngeal carcinoma
  • Radiotherapy

ASJC Scopus subject areas

  • Surgery

Cite this

Treatment of profuse epistaxis in patients irradiated for nasopharyngeal carcinoma. / Wong, George K.C.; Chan, Kin K.; Yu, Simon C.H.; Tsang, Raymond K.Y.; Poon, Wai-sang.

In: ANZ journal of surgery, Vol. 77, No. 4, 01.04.2007, p. 270-274.

Research output: Contribution to journalReview article

Wong, George K.C. ; Chan, Kin K. ; Yu, Simon C.H. ; Tsang, Raymond K.Y. ; Poon, Wai-sang. / Treatment of profuse epistaxis in patients irradiated for nasopharyngeal carcinoma. In: ANZ journal of surgery. 2007 ; Vol. 77, No. 4. pp. 270-274.
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abstract = "Background: Profuse epistaxis in patients with nasopharyngeal carcinoma (NPC) previously treated with radiotherapy (RT) can be life threatening. Surgical means to prevent rebleeding may at times be difficult and unsuccessful. We aim to investigate the characteristics of this group of patients and our experience of endovascular embolization technique in the management of epistaxis in this group of patients. Methods: A retrospective review of all nasopharyngeal carcinoma patients presented with profuse epistaxis during follow up after radiotherapy was carried out in a regional neurosurgical centre in Hong Kong. Seventeen patients were included for the analysis within the recent 6-year period. The age of patients was 55.5 ± 8.358 years (mean ± standard deviation). The sex ratio was 5:1 (M:F). Diagnostic catheter angiography was carried out in all 17 patients. Endovascular embolization was carried out in 11 patients with the joint decision of the otolaryngologist and neurointerventionist in charge. Results: Four patients underwent main trunk occlusion for internal carotid pseudoaneurysm. Seven patients underwent embolization of branches of external carotid artery. One patient required another session of external carotid artery embolization 1 month later. There was one inpatient death because of pneumonia and hepatic encephalopathy. With our protocol, there were only two patients (11.7{\%}) with delayed rebleed at 2 and 5 months, respectively. Both patients had advanced diseases and died. Conclusion: In irradiated patients with nasopharyngeal carcinoma presenting with profuse epistaxis, angiography had a high yield of pseudoaneurysm or hypervascularity and these lesions could be safely managed through endovascular embolization.",
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N2 - Background: Profuse epistaxis in patients with nasopharyngeal carcinoma (NPC) previously treated with radiotherapy (RT) can be life threatening. Surgical means to prevent rebleeding may at times be difficult and unsuccessful. We aim to investigate the characteristics of this group of patients and our experience of endovascular embolization technique in the management of epistaxis in this group of patients. Methods: A retrospective review of all nasopharyngeal carcinoma patients presented with profuse epistaxis during follow up after radiotherapy was carried out in a regional neurosurgical centre in Hong Kong. Seventeen patients were included for the analysis within the recent 6-year period. The age of patients was 55.5 ± 8.358 years (mean ± standard deviation). The sex ratio was 5:1 (M:F). Diagnostic catheter angiography was carried out in all 17 patients. Endovascular embolization was carried out in 11 patients with the joint decision of the otolaryngologist and neurointerventionist in charge. Results: Four patients underwent main trunk occlusion for internal carotid pseudoaneurysm. Seven patients underwent embolization of branches of external carotid artery. One patient required another session of external carotid artery embolization 1 month later. There was one inpatient death because of pneumonia and hepatic encephalopathy. With our protocol, there were only two patients (11.7%) with delayed rebleed at 2 and 5 months, respectively. Both patients had advanced diseases and died. Conclusion: In irradiated patients with nasopharyngeal carcinoma presenting with profuse epistaxis, angiography had a high yield of pseudoaneurysm or hypervascularity and these lesions could be safely managed through endovascular embolization.

AB - Background: Profuse epistaxis in patients with nasopharyngeal carcinoma (NPC) previously treated with radiotherapy (RT) can be life threatening. Surgical means to prevent rebleeding may at times be difficult and unsuccessful. We aim to investigate the characteristics of this group of patients and our experience of endovascular embolization technique in the management of epistaxis in this group of patients. Methods: A retrospective review of all nasopharyngeal carcinoma patients presented with profuse epistaxis during follow up after radiotherapy was carried out in a regional neurosurgical centre in Hong Kong. Seventeen patients were included for the analysis within the recent 6-year period. The age of patients was 55.5 ± 8.358 years (mean ± standard deviation). The sex ratio was 5:1 (M:F). Diagnostic catheter angiography was carried out in all 17 patients. Endovascular embolization was carried out in 11 patients with the joint decision of the otolaryngologist and neurointerventionist in charge. Results: Four patients underwent main trunk occlusion for internal carotid pseudoaneurysm. Seven patients underwent embolization of branches of external carotid artery. One patient required another session of external carotid artery embolization 1 month later. There was one inpatient death because of pneumonia and hepatic encephalopathy. With our protocol, there were only two patients (11.7%) with delayed rebleed at 2 and 5 months, respectively. Both patients had advanced diseases and died. Conclusion: In irradiated patients with nasopharyngeal carcinoma presenting with profuse epistaxis, angiography had a high yield of pseudoaneurysm or hypervascularity and these lesions could be safely managed through endovascular embolization.

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