Embolization – Episatxis (Nosebleed)
Why is this procedure done?
Embolization is a general term for closing off or blocking a vessel. Nosebleed embolization is performed to control severe nosebleeds, or mild nosebleeds in the back of the nose that an ear, nose and throat (ENT) surgeon has trouble gaining access to (or seeing). Most patients who have nosebleed embolization have been to an emergency room or their ENT and had packing placed to stop the bleeding. This can be uncomfortable and is often only a temporary fix, particularly for patients taking anti-platelet medications such as aspirin, Plavix, Brilinta or Effient, or blood thinners. Embolization of the small arteries that supply the back of the nose stops the bleeding and is often effective for many months.
How is embolization done?
Epistaxis (nosebleed) embolization is a treatment in which a catheter is placed into an artery in your groin or wrist and directed under an x-ray camera to the vessels supplying the back of the nose that need to be closed. Typically, a smaller catheter is positioned into the vessel as close to the site of occlusion (closure) as possible. Material is then injected or advanced through the smaller catheter to achieve vessel closure. The material may be small coils, small particles or a liquid material that hardens in the vessel. This is generally done using sedation or general anesthesia.
What are my risks? What are common complications?
All medical procedures have risks. The risks of nosebleed embolization can include bleeding at the site where the artery is entered, injury to the blood vessels that supply the brain and the development of blood clots inside of the blood vessels, resulting in a stroke. Because of the shared circulation with the blood supply to the eye, blindness is a possible risk, as well. As with any medical procedure, you should talk to your doctor about the risks versus the benefits.
What do I need to know before the procedure?
If anesthesia or sedation, is planned you may not eat or drink for at least six hours prior to the beginning of the procedure. X-ray dye may be used to map the blood vessels, so if you have a history of allergy to x-ray dye, you will need to start pretreatment medications the day before your procedure. Most embolizations can be done with a short hospital stay.
General discharge instructions
- You have received sedation/anesthesia for your procedure and that medication may still be in your system. We would like for you to take it easy the first day.
- Do not drive and avoid drinking alcohol.
- You may remove the bandage and shower the day after the procedure and start to resume regular activities. Do not soak the puncture site for two weeks (no tub bathing, swimming or getting into a hot tub).
- You may drive 24 hours after the procedure, as long as you have not been restricted for another reason.
- For five days following the procedure, do not exercise, lift objects greater than 10 pounds or do any strenuous activity.
- If you take Glucophage (metformin or metformin products), do not take it for two days after the angiogram; on the third day, start again as prescribed.
- Keep the puncture site clean and dry. Check it for redness, pain, swelling and a lot of bleeding or drainage. Call us if this happens.
- You may have soreness, a bruise or a knot where the needle was inserted for a few days or even weeks. This is normal.
- You may use over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) for minor discomfort, unless restricted for some other reason.
- Instructions related to the surgical packing in the nose will be given to you by your ENT. Many patients have the packing removed the next morning by the ENT surgeons. Some will leave the hospital and follow up with their ENT as an outpatient.
What should I expect while recovering?
- You will have a small bandage over the access site.
- You may remove the bandage the following day.
- You may shower the next day but do not soak the puncture site for two weeks (no tub bathing, swimming or getting in the hot tub).
- Keep the site clean and dry.
- You may have soreness, a bruise or a knot near where the needle was inserted for a few days to a few weeks. This is normal.
- Check the spot where the needle was put in for redness, pain, swelling and a lot of bleeding or drainage. Call us if this happens.
You may use over-the-counter medications such as acetaminophen (Tylenol) for minor discomfort, unless restricted for some other reason.