Refractory Posterior Epistaxis Research Articles

Management of Recurrent and Refractory Posterior Epistaxis by Transnasal Endoscopic Sphenopalatine Artery Cauterization: a Prospective Cohort Study

Management of Recurrent and Refractory Posterior Epistaxis by Transnasal Endoscopic Sphenopalatine Artery Cauterization: a Prospective Cohort Study

Bilateral Sphenopalatine Artery Embolization in A Low-Energy Facial Trauma: Case Report and Literature Review

Epistaxis is very frequented emergency faced by ENT practician around the world, commonly benign but can lead to dangerous morbidities if refractory. Surgical is the standard treatment and embolization and endoscopic ligation are the emergent routes of treatment constituting the main arsenal to face refractory epistaxis with similar success rate. We thus report a low energy-traumatic bilateral refractory posterior epistaxis treated with arterial embolization with no rebleeding up to 6-monthmarque follow-up.

Competence of Cauterization of Sphenopalatine Artery for Idiopathic Refractory Posterior Epistaxis

Competence of Cauterization of Sphenopalatine Artery for Idiopathic Refractory Posterior Epistaxis

Endoscopic Sphenopalatine Artery Ligation in Posterior Epistaxis

Introduction: Posterior epistaxis brings us with a more challenging condition that can even threaten the life of a patient. Approaching the posterior nasal cavity is not an easy task because of its anatomical complexity and impending vision by turbinate. Increase endoscopic anatomic details of lateral nasal wall and endoscopic expertise with high definition camera leads to a higher success rate of endoscopic sphenopalatine artery ligation.Methods: This prospective study was conducted in patients with refractory posterior epistaxis between January 2017 to December 2019. All patient who had undergone Endoscopic Sphenopalatine artery ligation were included in this study. The site of bleeding was confirmed with the help of a rigid endoscope. Bipolar cauterization or clipping was performed to stop bleeding. Data analysis was done by using SPSS 26.0 version.Results: Twenty nine patients who had undergone Endoscopic sphenopalatine artery for posterior epistaxis were included during this study period. The mean age of the patient was 53.31 ± 18.65years. The site of bleeding was mostly from the left in 20 (75.9%) cases and 10 (34.4%) cases had severe bleeding that needed a blood transfusion. No recurrence of bleeding was found during follow up period. The severity of bleeding was significantly correlated with the age of patients (p<0.003). Out of 29 patient, 27 patients had undergone bipolar diathermy and 2 patients clipping was done.Conclusion: Sphenopalatine artery ligation is an effective management strategy for surgical control of refractory epistaxis. The early timing of sphenopalatine artery ligation may lead to reductions in length of stay.

Success Rate of Endoscopic Sphenopalatine Artery Ligation for the Management of Refractory Posterior Epistaxis Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Epistaxis is a common medical emergency with 5% to 15% of patients admitted for epistaxis will require surgical management as nasal packing has high failure rates. A modern endoscopic technique like Endoscopic Sphenopalatine Artery Ligation has increased in popularity for managing intractable posterior epistaxis. It has less complication and a high success rate. The study conducted to estimate the success rate of Endoscopic Sphenopalatine Artery Ligation of refractory posterior epistaxis among admitted patients in a tertiary care hospital. This is a descriptive cross-sectional study conducted from June 2019 to June 2020 at the Department of Otorhinolaryngology, Nobel Medical College and Teaching Hospital among the patient with refractory posterior epistaxis with the help of retrospective data. A convenient sampling method was used. These patients underwent endoscopic sphenopalatine artery cauterization for recurrent/intractable posterior epistaxis. Ethical clearance was taken from the Institutional Review Board. Data were analyzed in Statistical Package for the Social Sciences. Out of the total patient with refractory posterior epistaxis who underwent Endoscopic Sphenopalatine Artery Ligation, the overall success rate was 39 (95.12%). Among them, 25 (60.97%) males and 16 (39.02%) females underwent endoscopic sphenopalatine artery ligation. Twenty (48.78%) of them were unilateral whilst 21 (51.21%) were bilateral disease. About 2 (4.8%) cases had re-bleeding within 48 hours which was managed conservatively. Hypertension was found to be the most common comorbid condition followed by diabetes, chronic kidney. From our study, we conclude that the success rate for Endoscopic Sphenopalatine Artery Ligation in a patient with refractory posterior epistaxis was high.

Endoscopic Cauterization Versus Clipping of Sphenopalatine Artery in the Management of Intractable Posterior Epistaxis

AbstractBackground: Endoscopic ligation of the sphenopalatine artery is a safe, simple and effective procedure in the man-agement of refractory posterior epistaxis. Both modalities (cauterization, clipping) show good efficacy in controlling posterior epistaxis with slight advantage of clipping that it showed less post-operative complications.The Aim of study: This work was to compare the efficacy of endoscopic sphenopalatine artery cauterization versus clipping in the management of intractable posterior epistaxis.Patients and Methods: Forty patients were selected for this prospective study in the period between October 2016 to April 2017 at Otolaryngology Department, Tanta University Hospital complaining of recurrent epistaxis (26 males and 14 females). The patient ages ranges between 18-60 years. We selected patients who didn't have history of sinonasal trauma, tumours or bleeding disorders. Twenty patients of the study had an endoscopic sphenopalatine artery clipping, the other twenty had sphenopalatine artery cauterization. The choice between the two surgical techniques has been randomized and all patients have been operated by the same doctor.Results: Among the first group who had SPA cauterization 5 patients had recurrent epistaxis in the 4th, 5th, 6th, 8th day and after 1 month respectively thus success rate among this group is 75%. Two patients in the group who had sphenopal-atine artery clipping had recurrent epistaxis in the 6th and 7th day with success rate 90%.Conclusions: Both modalities (cauterization, clipping) show good efficacy in controlling posterior epistaxis with slight advantage of clipping that it showed less post-operative complications.

Endoscopic cauterization of the sphenopalatine artery to control severe and recurrent posterior epistaxis.

Epistaxis is one of the most common medical emergencies, making the management of posterior epistaxis a challenging problem for the ear, nose, and throat (ENT) surgeon. In the cases of conservative management failure, ligation of the major arteries or percutaneous embolization of the maxillary artery is performed routinely in most units, but rates of failure and complications are high. The objective of this study was to assess the effectiveness of endoscopic sphenopalatine artery (SPA) cauterization in patients with refractory posterior epistaxis. Between April 2011 and January 2012, 27 patients (15 males and 12 females) with refractory posterior epistaxis underwent endoscopic SPA cauterization in two tertiary referral hospitals in Shiraz. Three patients underwent bilateral cauterization. Four patients (from 30 arteries) had new epistaxis after surgery, three experienced subsequent epistaxis requiring medical treatment, and one patient had a minor epistaxis not needing treatment. The SPA electrocoagulation technique seems to be safe, simple, fast, and effective with low rates of morbidity and complications for the management of refractory posterior epistaxis. Endoscopic SPA cauterization should be considered as an immediate second-line management when conservative treatment as first-line management fails.

Embolization for control of refractory posterior epistaxis

ObjectivesMany methods are included in the treatment of intractable epistaxis including selective embolization. We report our experience with 10 patients treated with this technique. Patients and methodsTen patients with posterior idiopathic epistaxis were selected in this study. They were managed by double-balloon device followed by embolization. ResultsStudy included six males and four females, their age ranged from 49 to 66years (mean 56years). Four patients were hypertensive, two were smokers. Epistaxis was unilateral in six patients and bilateral in four. Six internal maxillary and eight sphenopalatine arteries were embolized with polyvinyl alcohol 150–250μm. Bleeding stopped in all patients after procedure. One patient had recurrent attack 2months later for whom re-embolization successfully stopped bleeding. No major complications encountered but minor complications occurred in two patients (one severe headache and one transient left temporofacial pain). ConclusionSelective embolization is a clinically effective treatment for severe refractory posterior epistaxis. By this method we can avoid the complications of repeated packs and surgery especially in elderly patients.

Endoscopic devascularisation of sphenopalatine bundle in intractable posterior epistaxis: technique, efficacy and safety

To evaluate endoscopic cauterisation of the sphenopalatine neurovascular bundle, as treatment for intractable posterior epistaxis, with regard to efficacy, safety and post-operative sequelae. A prospective study reviewed 42 patients with severe posterior epistaxis who were treated with endoscopic cauterisation of the sphenopalatine neurovascular bundle, over a 17-month period. Hypertension and hepatic disease were present as predisposing factors in 66.7 and 35.7 per cent of patients, respectively. Branching of the sphenopalatine artery at its foramen was present in more than 85 per cent of patients. The success rate was 100 per cent, with no recurrent epistaxis in the follow-up period. Severe nasal dryness was present in only four patients (9.5 per cent); hypoaesthesia was found in the nasal mucosa of eight patients, without any patient complaints. Endoscopic sphenopalatine neurovascular bundle cauterisation is an effective treatment for refractory posterior epistaxis. In this study, neurovascular bundle cauterisation did not cause any neurological deficits or major complications.

Endoscopic sphenopalatine artery ligation or diathermy

Refractory posterior epistaxis is frustrating for patients and a common challenge for otolaryngologists. Patients who, despite conventional methods based on nasal packing, continue to bleed are referred for surgical treatment. With the advent of and experience with endoscopic procedures, the surgical strategy has changed from transantral internal maxillary ligation to sphenopalatine artery ligation or diathermy. This minimally invasive intervention is effective and significantly reduces the discomfort for the patient. We show our method for performing endoscopic sphenopalatine ligation or diathermy.

How we do it: a practical approach to Foley catheter posterior nasal packing

There are various effective treatment options for refractory posterior epistaxis including endoscopic diathermy or endoscopic artery ligation. If these treatment options are not immediately available, posterior nasal packing with Foley catheter is an effective and rapid non-surgical treatment alternative. A systematic approach is presented. The principles and mechanisms of action of the posterior nasal packing are explained. Nevertheless, there are morbidities involved and posterior packing can be painful and uncomfortable for the patient. Marking and modifying the catheter will help one inflate the balloon in the correct place and avoid the problem of nasal alar pressure necrosis.

Embolization for the Treatment of Idiopathic Posterior Epistaxis

The goal of this study was to examine safety and efficacy of transarterial embolization for the treatment of idiopathic posterior epistaxis. A retrospective chart review was conducted to characterize the underlying conditions of eighty-one consecutive patients for whom complete records were available presenting with posterior epistaxis, the associated risk factors for patients with idiopathic posterior epistaxis, and the success rate of embolization in this patient population. One hundred consecutive patients undergoing embolization for epistaxis were identified and 81 patients were included in the analysis. Nineteen patients did not have sufficient and retrievable medical records to be included in the study. Idiopathic posterior epistaxis was the most common underlying etiology of patients with refractory posterior epistaxis (34%). Hypertension, vascular disease, and diabetes were frequently detected comorbid diseases. Patients were equally as likely to be hypertensive as normotensive at the time of presentation (45 and 55%, respectively). Most patients (83%) had failed at least one prior treatment modality. Few patients had a recurrence of epistaxis within 72 hours (three patients [12%]) or had an adverse effect associated with embolization (three patients [12%]). Embolization for the treatment of posterior epistaxis is a safe and effective treatment modality.

Endoscopic Anatomy of the Sphenopalatine and Posterior Nasal Arteries: Implications for the Endoscopic Management of Epistaxis

Refractory posterior epistaxis is a challenge for otolaryngologists. Most algorithms for managing this condition ultimately call for interrupting the arterial blood supply to the nasal mucosa. Traditionally, this was accomplished either by transantral arterial ligation or by arteriographic-guided embolization. More recently, the endonasal endoscopic approach has also been described. Because the primary blood supply to the posterior nasal cavity is derived from the terminal branches of the sphenopalatine and the posterior nasal arteries, we conducted this anatomic study to examine and describe the anatomic relationship of these two arteries as they exit the pterygopalatine fossa and enter the nasal cavity. We performed endoscopic dissections of this anatomic region in nine fresh and one formalin-preserved cadaver specimens. A total of 19 sides were examined. In 3 of 19 specimens (16%), the sphenopalatine artery branched from the sphenopalatine artery within the sphenopalatine canal, allowing the two arteries to exit together. In 8 of the 19 specimens (42%), the sphenopalatine artery exited much more posteriorly, yet from within a shared posteriorly elongated sphenopalatine foramen. In the remaining eight specimens (42%), the sphenopalatine artery exited through a distinct foramen directly posterior to the larger sphenopalatine foramen. Understanding this anatomic relationship is important in performing endoscopic arterial ligation. If the sphenopalatine artery is not specifically identified and ligated, an important component of the posterior nasal circulation will not be addressed adequately by this surgical approach.

Endoscopic ligation of the sphenopalatine artery for refractory posterior epistaxis.

The management of patients with posterior epistaxis remains a challenging problem for the ENT surgeon. In most units, failure of conservative management results in more invasive techniques, involving either major artery ligation or percutaneous embolization of the internal maxillary artery. However, there are complications in more than 25% of patients undergoing these techniques. Endoscopic ligation of the sphenopalatine artery (ELSPA) is emerging as a minimally invasive alternative. We report our experience of ELSPA in 13 patients with a mean follow-up of 13 months. Epistaxis was controlled in 92% and to date no complications have been associated with the procedure. We conclude that ELSPA is a treatment option that is easy to perform and is safe and effective for patients with refractory posterior epistaxis.

Comparison of internal maxillary artery ligation versus embolization for refractory posterior epistaxis

OBJECTIVE: This study examined the advantages and disadvantages of internal maxillary artery (IMA) ligation versus embolization for the treatment of refractory posterior epistaxis. METHODS: Thirty-nine patients underwent 42 procedures for treatment of posterior epistaxis at the University of Cincinnati Medical Center between 1986 and 1994. Complication rates, failure rates, demographics, and the costs of IMA ligation and embolization were compared. A review of 20 studies published between 1973 and 1995 was done to determine the complication and failure rates of IMA ligation and embolization. Finally, a mail survey was used to determine the availability and use of IMA ligation and embolization by urban and rural otolaryngologists in Ohio. RESULTS: Complication and failure rates of IMA ligation and embolization were similar at our institution. In the literature review, IMA ligation had a higher complication rate, but fewer failures. Although the major complication rates were not significantly different, those associated with embolization were often more serious than those associated with IMA ligation. At our institution, the cost of IMA embolization was significantly lower than the cost of IMA ligation. Only 11% of Ohio otolaryngologists in nonurban areas have embolization available to treat posterior epistaxis. CONCLUSION: IMA ligation is more effective than IMA embolization but may be associated with a higher minor complication rate. The major complications that occur with IMA embolization are often more serious. Although IMA embolization was less expensive at our institution, it is unavailable in most nonurban regions in Ohio. Training in the use of IMA ligation for refractory posterior epistaxis should continue in otolaryngology residency training programs despite the increasing availability of embolization at university training centers. (Otolaryngol Head Neck Surg 1998;118:636-42.)

Management of Refractory Posterior Epistaxis by Sphenopalatine Artery (SPA) Cauterization

Keywords: Epistaxis; Sphenopalatine artery; endoscopic surgeryDOI: 10.3126/njenthns.v1i1.4727 Nepalese J ENT Head Neck Surg Vol.1 No.1 (2010) p.3-5