Retrospective analysis of massive epistaxis and pseudoaneurysms in
nasopharyngeal carcinoma after radiotherapy
Abstract
Objectives This article focuses on massive epistaxis and pseudoaneurysm
in patients with NPC after radiotherapy and discusses clinically
relevant treatment strategies. Design Retrospective the medical data of
NPC patients with massive epistaxis after radiotherapy and review the
English literature over the past 10 years. Setting Otorhinolaryngology
department in the First Affiliated Hospital of Nanchang University.
Participants 21 patients with massive epistaxis after radiotherapy for
NPC. Main outcome measures Characteristics and related causes of massive
epistaxis or pseudoaneurysms were analyzed in terms of the clinical
stage of NPC, course of radiotherapy, and affected artery. An analysis
was performed on the methods of endovascular interventional treatment of
such pseudoaneurysms. Results 19 cases were accompanied with bone
destruction of the skull base; 13 cases were found tumor recurrence; 15
cases were in stage III or IV of NPC; 14 cases were combined with
pseudoaneurysms. Analysis with the imaging of pseudoaneurysms, we found
that the petrous ICA was the most predilection site. There were 11 out
of 14 pseudoaneurysms had sentinel hemorrhage in the initial phase. All
14 pseudoaneurysm patients were underwent endovascular interventional
therapy, but one died from hemorrhagic shock during the procedure. There
were no rebleeding again among other patients. Conclusions
Pseudoaneurysm could cause massive epistaxis with high mortality. The
formation of a pseudoaneurysm was closely associated with a high
carcinoma stage, re-radiotherapy, and local bone destruction and
infection. Most cases had sentinel epistaxis. The imaging material
prompted that pseudoaneurysm had a predisposition to the petrous part of
the ICA, while the preferred therapy was endovascular embolization
treatment. Key poits 1.Patients with massive epistaxis mean a single
nasal bleeding volume exceeded 100 ml, or cumulative bleeding volume was
more than 300 ml. 2.Patients who presented with active oronasal bleeding
should be rapidly managed by nasal packing. 3.When there is hemorrhagic
shock, patients should undergo endotracheal intubation and blood
transfusion before being transferred to the otorhinolaryngology
department. 4.CTA and DSA are recommended for patients with massive
epistaxis associated with NPC after radiotherapy. 5.Interventional
embolization is recommended to patients with pseudoaneurysm.