The use of transcatheter embolization in the treatment of external carotid artery (ECA) branch active extravasation has emerged as a viable treatment option where conservative basic management has failed, particularly in epistaxis and carotid blowout syndrome.

Epistaxis is common, with an estimated prevalence of up to 60% in the general population (1), out of which approximately 80% arise from an anterior source (2) which are usually self-limiting. A minority of cases arise from a posterior source, most commonly from branches of the sphenopalatine artery which may result in significant haemorrhage not amenable to non-invasive management, hence, necessitating surgical management or angiographic embolization. The nasal cavity arterial supply is rich, derived from both internal and external carotid arterial circulation as well as...

8 patients who presented with epistaxis and carotid blowout syndrome secondary to various etiologies and treated with different methods of embolization were selected. The 1st patient presented with intractable epistaxis due to extensive traumatic facial fractures. Selective catheter angiography found the source to be a pseudoaneurysm within the distal maxillary artery which was successfully embolized with microcoils and microparticles (Figure 1). [Fig 1] The 2nd patient presented with recurrent epistaxis secondary to a juvenile nasopharyngeal angiofibroma, which was supplied by the right distal maxillary artery,...

Endovascular embolization is a safe procedure in external carotid territory exsanguinating bleeds with rewarding outcomes. High degree awareness of the internal and external communications is paramount before undertaking external carotid embolization.

J. Chaganti: Nothing to disclose

Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician. 2005;71(2):305-11. Schaitkin B, Strauss M, Houck JR. Epistaxis: medical versus surgical therapy: a comparison of efficacy, complications, and economic considerations. Laryngoscope. 1987;97(12):1392-6. Chaloupka JC, Putman CM, Citardi MJ, Ross DA, Sasaki CT. Endovascular therapy for the carotid blowout syndrome in head and neck surgical patients: diagnostic and managerial considerations. AJNR Am J Neuroradiol. 1996;17(5):843-52. Powitzky R, Vasan N, Krempl G, Medina J. Carotid blowout in patients with head and neck cancer. Ann Otol Rhinol Laryngol....