Endovascular Management of Malignant Epistaxis in Patients with Hereditary Hemorrhagic Telangiectasia

Introduction: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic condition, which is diagnosed based on strict criteria. The main symptoms include recurrent epistaxis episodes, multiple mucocutaneus telangiectasia, the presence of organ arteriovenous malformations (AVMs) and a family history of the disease. Up to 98% of patients present with epistaxis episodes, some of which could potentially be life threatening. Different approaches have been used in historical perspective to gain control over the site of bleeding, with hemodynamically unstable patients requiring urgent medical supportive care. Endovascular therapy is a still relatively unexplored treatment option for such cases. Purpose: To establish the safety and efficacy of endovascular embolization as a treatment option of malignant refractory epistaxis in patients with HHT. Materials and methods: We present a case series of endovascular embolizations of the maxillary artery and/or its branches, supplying bleeding lesions in patients, refractory to other conventional means of treatment. Between the period of February 2022 and March 2024, nine patients with HHT underwent such an endovascular procedure. Results: Satisfactory results were achieved in all cases, with no added neurological complications being observed. Only one of the patients had a recurrence of the condition and required an additional embolization procedure. Conclusion: Endovascular embolization of the maxillary artery and its branches for malignant recurrent epistaxis in patients with HHT is a safe and effective way to control the site of bleeding.