The management of refractory epistaxis: A proposed treatment algorithm

OBJECTIVES: To understand the management of patients with refractory epistaxis and know which patients may benefit from surgery versus embolization. Study Design: A case report of two patients presenting with refractory epistaxis at a tertiary care institution. A review of the literature will help formulate an algorithm for management of this condition. Methods: A cohort of patients treated at a tertiary care institution were evaluated and treated by either embolization or surgical intervention. A review of the literature was performed to create an algorithm in the management of patients with refractory epistaxis. Results: All patients were successfully treated by either embolization or surgical intervention. One patient who presented with refractory epistaxis during pregnancy was successfully treated with surgical ligation. One patient with severe peripheral vascular disease suffered loss of vision after embolization. Important considerations will be discussed in selecting particular treatment modalities and a treatment algorithm will be presented. Conclusions: The management of epistaxis has evolved to utilize a myriad of treatment modalities, both nonsurgical and surgical techniques. Proper knowledge of which patients would benefit from either modality is imperative in the decision making process.