Narrative review suggests endovascular treatment may be feasible and safe for posterior epistaxis

A narrative review based on a semi-systematic search examined the role of endovascular treatment in patients with posterior epistaxis. The review compared endovascular approaches to traditional management methods, though specific comparator details and primary outcomes were not reported. The main finding was that endovascular treatment appears to be a feasible and safe option, but the review did not provide specific effect sizes, absolute numbers, or statistical measures to quantify this assessment.

Regarding safety, the review noted the potential for serious complications, including stroke or blindness, from inadvertent embolization in dangerous communications around the skull base. Specific rates of adverse events, serious adverse events, or treatment discontinuations were not reported. The authors emphasized that thorough angiographic assessment is required before proceeding with endovascular treatment to identify these hazardous anastomoses.

Key limitations include the narrative and semi-systematic nature of the review; the certainty of the evidence is therefore limited. Sample size, follow-up duration, and specific study settings for the included evidence were not reported. The review's conclusions are based on association, not causation, and do not establish efficacy or superiority over traditional approaches.

For practice, the authors suggest endovascular treatment could be a viable option for posterior epistaxis and should not be reserved solely as a last resort. However, this recommendation is tempered by the evidence's narrative quality and the serious, albeit rare, risk of catastrophic neurological complications. Clinicians must weigh these potential benefits against the procedural risks and the limited comparative effectiveness data available.