Surgical treatments such as suturing of Little’s area or liver transplantation in HHT are considered more aggressive and are associated with surgical risks.25, -27 Radiofrequency ablation of Kiesselbach’s plexus can lead to septal perforation and is not a definitive treatment.28 HHT is associated with increased levels of vascular endothelial growth factor (VEGF) leading to the development of multiple telangiectasia and AVMs.29 Bevacizumab, a VEGF inhibitor, is a most expensive drug and not widely studied to control epistaxis in HHT, due to rareness of this disease. This evidence concerns the gene VEGFA and epistaxis.