Factors Affecting the Success of Sphenopalatine Artery Ligation in the Management of Intractable Epistaxis-A...

BackgroundEndoscopic sphenopalatine artery ligation (ESPAL) is a safe and effective procedure to manage intractable epistaxis. However, in the literature, the peri-operative and patient factors which contribute to surgical success or failure have been poorly defined.ObjectiveThe purpose of this study was to identify the patient, disease and surgical factors which influence the effectiveness of ESPAL in the management of intractable epistaxis.MethodsAll ESPALs performed over a 14-year period at a single tertiary otolaryngology department to manage epistaxis refractory to conservative management were retrospectively analyzed. Recurrence of epistaxis was defined as any patient who presented to an emergency department with epistaxis on the same side as their previous ESPAL at any time post-operatively. Subjects were grouped as either a non-recurrence or recurrence group.Results40 patients underwent ESPAL to treat intractable epistaxis. Anticoagulation, smoking, and active malignancy were associated with higher rates of recurrence after ESPAL (P < .05). The recurrence rate was 20% with an average follow-up period of 5 years. The average time between ESPAL and epistaxis recurrence was 10 days. 50% (n = 4) of patients with recurrence required escalation to endovascular embolization. No patients had recurrence of epistaxis following additional radiological intervention.ConclusionOne in five patients experienced a recurrence in epistaxis following ESPAL within 3 weeks of their surgery. Smokers, patients on anticoagulation and patients with malignancy are more likely to experience recurrence. If re-presenting with epistaxis following ESPAL, patients are likely to require radiological intervention.