Nosebleed won’t stop? Coil surgery might help

A small study suggests that a surgical treatment generally used on patients with tumors and certain brain disorders may put a stop to nosebleeds that won’t stop any other way.

The surgery - which involves injecting coils into the arteries of the nose through arteries in the leg - isn’t for everyone. For most people, home remedies such as pressure and tissues work just fine. If they’re not enough, doctors may pack the nasal passages with gauze, or sear the bleeding shut using cauterization.

But the author of the study told Reuters Health that about one percent of the population - generally older adults taking blood thinners - suffers from uncontrollable nosebleeds severe enough that surgery may be considered.

The study, published today in the Journal of NeuroInterventional Surgery, tracked 20 such patients who had received the coil treatment. Dr. Walter Lesley, lead author of the study and director of neuroradiology at the Scott & White Clinic in Temple, Texas, and colleagues monitored patients for 30 days, after which 18 of the 20 needed no further surgery.

One patient had another procedure to control bleeding, while another died of unrelated causes.

The study, say the authors, is an important step in figuring out which kind of surgery is safest and most effective.

“There really isn’t a lot of good numerical data on using coils at all for nosebleeds,” Lesley told Reuters Health. “Our results were encouraging and certainly warrant a larger study comparing (the procedure) head to head with other methods.”

Doctors use a few other surgeries to treat severe uncontrollable nosebleeds, including a catheter to plug an artery with sponge-like particles, rather than coils, and tying off an artery in the back of the nose with a staple-like clip.

The current study did not directly compare different treatment methods, but the coil method had a lower failure rate and fewer serious complications than other methods have in other studies. Those complications - which can include stroke and blindness - affected none of the study’s participants.

The risks may be different, said Dr. Peter Willems, a neurosurgeon at Leiden University Medical Center in the Netherlands, because the coils don’t penetrate as far into the nasal artery as smaller particles. While this could reduce the possibility of some complications, it may make it more difficult to repeat the surgery on those who need it.

Dr. Richard Orlandi, an ear, nose and throat specialist at the University of Utah, believes that each of the procedures is relatively safe, and that the question comes down to cost and availability. Orlandi and his colleagues published a study in 2005 which found that the cost of a procedure similar, but not identical, to the one tested here was $14,088 per patient, compared to $7,561 for a procedure that clipped the nasal artery.

“Performing this procedure really does require a fair amount of skill by a radiologist,” which could be a problem in rural settings, he told Reuters Health.

Lesley said the platinum-coil based procedure takes about an hour to complete, and patients either go home that day or the next morning - similar to the recovery time for other treatments.

The researcher said the need for such procedures could grow “because of the benefits of new drugs that thin the blood and can cause more bleeding problems.”

SOURCE:  Journal of NeuroInterventional Surgery, May 27, 2010.

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