Otolaryngologia Polska tom 63, nr 6, listopad–grudzień 2009 KAZUISTYKA / CASE REPORTS 520 Endovascular Treatment of Hereditary Hemorrhagic Telangiectases of the Tongue Endowaskularne leczenie wrodzonej naczyniakowatości krwotocznej języka Assist. Prof. Dragan Stojanov 1 , Prof. Petar Bosnjakovic 1 , Dr. Sasa Ristic 1 , Mila Bojanovic 2 , Dr. Daniela Benedeto-Stojanov 3 Otolaryngol Pol 2009; 63 (6): 520-522 SUMMARY Hereditary hemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, is an autosomal dominant disorder involving vascular abnormalities of various organs. Telangiectases are frequently observed, predominantly on the nasal and oral mucosa. We present a case a of 53-year-old man with the tonge hemorrhagic telangiectases and epistaxis. Selective catheterization and embolization of the right lingual artery led to size redution and no bleeding from tongue telangiectases. Hasła indeksowe: wrodzona naczyniakowatość krwotoczna, leczenie endowa- skularne Key words: hereditary hemorrhagic telangiectases, endovascular treatment ©by Polskie Towarzystwo Otorynolaryngologów – Chirurgów Głowy i Szyi Otrzymano/Received: 02.11.2009 Zaakceptowano do druku/Accepted: 08.12.2009 1 Institute of Radiology, Clinical Centre Nis 2 ORL Clinic, Clinical Centre Nis 3 Clinic for Gastroenterology and Hepatology, Clinical Centre Nis Wkład pracy autorów/Authors contribution: Według kolejności Konflikt interesu/Conflicts of interest: Autorzy pracy nie zgłaszają konfliktu interesów. Adres do korespondencji/ Address for correspondence: imię i nazwisko: Prof. Dragan Stojanov adres pocztowy: Institute of Radiology, Clinical Centre Nis Bul. Dr. Zorana Djindjica 48 18000 Nis Serbia tel. +381631094197 fax +381184221469 e-mail drstojanov@gmail.com Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant disorder involving vascular abnormalities of various organs. Telangiectases are frequently ob- served, predominantly on the nasal and oral mucosa and the skin of the face and hands [1, 2]. This results in recurrent and sometimes severe bleeding, of which epistaxis is the most common. Prolonged hemorrhages originated from telangiectases of the base of the tongue and the body of the tongue may requir treatment. To our knowledge, there are no case reports of endovascular treatment of the tongue hemorrhagic telangiectases. The purpose of this report is to present endovascu- lar treatment of hereditary hemorrhagic telangiectases of the tongue. Case report A 53-year-old man presented with the tonge hemor- rhagic telangiectases and epistaxisi. He had a family history of HHT manifesting as telangiectasia of gas- trointestinal (GI) tract and nasal mucosa. His medi- cal history was significant for multiple mild to sever nosebleeds, GI bleeds and a minor cerebral stroke. At admission on ORL Clinic, patient had severe epistaxis physical examination revealed multiple telangiectases of the nasal mucosa (Fig. 1). In addition, scattered telangiectases on the tongue were found (Fig. 1). The patient underwent posterior nasal tamponade by ORL spetialist. As nasal tamponade was not effective, en- dovascilar treatment of the epistaxis was indicated. After obtaining informed consent, patient was brought to the angiography suite. Procedure was per- formed by using conscious sedation and local an- esthesia. Using standard technique, procedure was performed with femoral artery access. After placement of 5F arterial sheath, a 5F catheter was placed in the right common carotid artery, and cervical angiography was performed. Selective internal carotid artery (ICA) and external carotid artery (ECA) digital subtraction angiography was then performed with imaging over the face and skull base. After placing the catheter in the proximal ECA trunk and performing an initial control angiogram, catheter was then advanced over a guidewire into the internal maxillar artery. After the embolization of the internal maxillar artery, catheter was advanced in the lingual artery and a superselective angiogram was performed. It showed the characteristic patchy mucosal telangiectasias on the thong apex and body (Fig. 2). Embolization was performed using 3 ml of polyvinyl alcohol (PVA) microspheres (Bead Block Terumo) in range 300-500 μm. Embolization resulted in occlu- sion of the small branches of the lingual artery and