Office-sclerotherapy for Epistaxis Due to Hereditary Hemorrhagic Telangiectasia

Ninety percent of patients who suffer from Hereditary Hemorrhagic Telangiectasia (HHT)
experience epistaxis which can range from mild to recurrent, severe, life threatening
episodes. Current methods to treat significant epistaxis have limitations, namely the need
for general anesthesia and repeated treatments. The objective of this study is to test a
novel and tolerable office-based treatment method, sclerotherapy with sodium tetradecyl
sulfate (STS), for recurrent epistaxis related to HHT.

Sclerotherapy is the treatment of vascular lesions by injection with an agent which causes
thickening of the vessel wall, obstruction of blood flow, clot formation and collapse of the
lesion. Sclerotherapy is an established treatment modality for vascular malformations in the
skin, GI tract, genitourinary tract and has been used for lesions in various sites in the
head and neck. STS is an anion surfactant (detergent) that is commonly used for
sclerotherapy. There are case reports in the literature describing sclerotherapy treatments
for epistaxis related to HHT using other agents, but these case reports did not lead to
prospective studies. We have performed a pilot study to analyze the tolerability and
effectiveness of sclerotherapy with STS in a series of patients with recurrent epistaxis
related to HHT. In our series, the treatment was found to be well tolerated and effective,
based on patient administered questionnaire and review of clinical data. No complications
related to the procedure were noted. Further prospective studies would help elucidate the
role of sclerotherapy with STS in the treatment algorithm for recurrent epistaxis related to
HHT.

Our goal is to conduct a prospective, randomized-controlled trial to test the efficacy and
tolerability of sclerotherapy using STS in the treatment of recurrent epistaxis due to HHT. A
modified crossover design will be utilized with the intervention group receiving
sclerotherapy, plus any additional, previously utilized standard treatment methods needed to
control epistaxis. The control group will receive their current standard treatment methods,
followed by delayed intervention with sclerotherapy. The primary outcomes will be frequency
and severity of epistaxis. Secondary endpoints will be hemoglobin level, tolerability of
treatment, additional treatment requirements, and quality of life.

Inclusion Criteria:

- a clinical diagnosis of HHT based on the Curacoa Criteria

- age 18 and older

- cognitive ability and willingness to sign the study consent form and complete the
study forms and questionnaires

Exclusion Criteria:

- previous sclerotherapy with Sodium Tetradecyl Sulfate