Use of selective arteriography in the treatment of epistaxis.

Selective carotid arteriography can provide useful information in patients with massive epistaxis. It is limited in application because special techniques and preparation are necessary. Careful selection of patients is mandatory. It is not appropriate as a screening procedure for all patients with epistaxis. The procedure is especially useful when previous surgical control of the bleeding site has failed. Residual branches of the internal maxillary and ethmoid arteries are readily identified. The development of collateral blood flow to the nasal area from many sources can be recognized. The complexity of collateral blood flow emphasizes the necessity for controlling hemorrhage as close to the source as possible. At the same time, it suggests that long-term control of bleeding in the nasal area may fail due to this vast network of vessels.