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Objective: Massive epistaxis after radiotherapy for nasopharyngeal carcinoma (NPC) is a common clinicalcritical illness, which often leads to death of patients. This article focuses on the relationship betweenmassive epistaxis and pseudoaneurysm after radiotherapy in patients with NPC and discusses clinicallyrelevant treatment strategies.Methods: A review was performed in 21 patients with massive epistaxis after radiotherapy for NPC fromJanuary 2011 to December 2019, and all of the patients were examined by computed tomographyangiography (CTA). We also reviewed the English literature over the past 10 years to analyse thecharacteristics and related causes of pseudoaneurysms in terms of the clinical stage of NPC, course ofradiotherapy, and affected artery. An analysis was performed on the methods of endovascular interventionaltreatment of such pseudoaneurysms.Results: Among the 21 patients with massive epistaxis after radiotherapy for NPC, 19 (90%) cases hadaccompanying bone destruction of the skull base; 13 cases (62%) showed tumor recurrence; 15 cases (71%)were in stage III or IV of NPC; 14 cases (67%) had combined pseudoaneurysms, including 9 cases occurringin the internal carotid artery (ICA) and 5 cases occurring in the external carotid artery (ECA). These datawere consistent with the results of literature review. On analysis with imaging, we found that suchpseudoaneurysms are associated with necrosis and infection of the local bone and soft tissue, and that thepetrous part of the ICA was the most common predilection site. We also found that 11 of 14pseudoaneurysms caused sentinel hemorrhage in the initial phase. In addition to anterior and posterior nasalpacking, endovascular interventional therapy was the most important management option. All 14 patientswith pseudoaneurysms underwent endovascular interventional therapy, but 1 patient died due tohemorrhagic shock during the procedure. Among the others, 9 patients underwent occlusion of the ICA orECA with a stainless-steel coil, and rebleeding did not occur again. One patient underwent selected vascularembolization with a covered stent. Direct occlusion of the pseudoaneurysm was performed in 3 patients.Conclusion: Pseudoaneurysm, which was a serious complication after radiotherapy in patients with NPC,could cause massive epistaxis with high mortality. The formation of a pseudoaneurysm was closelyassociated with a high carcinoma stage, re-radiotherapy, and local bone destruction and infection. Mostcases had sentinel epistaxis, which was considered the bleeding characteristic. The imaging materialprompted that pseudoaneurysm had a predisposition to the petrous part of the ICA, while the preferredtherapy was endovascular embolization treatment.

Correlative Analysis of Massive Epistaxis and Pseudoaneurysms in Nasopharyngeal Carcinoma after Radiotherapy and a 10-Year Review