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

Abstract

Introduction: 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.
 
 Methods: 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.
 
 Results: 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.
 
 Conclusions: From our study, we conclude that the success rate for Endoscopic Sphenopalatine Artery Ligation in a patient with refractory posterior epistaxis was high.

Peri-operative complications of sphenopalatine artery ligation: a 10-year series from two secondary care centres

“…These figures are similar to findings from previous studies, suggesting that sphenopalatine artery ligation is an effective treatment modality for persistent epistaxis. 3,5,6,8,15–17…”

“…These figures are similar to findings from previous studies, suggesting that sphenopalatine artery ligation is an effective treatment modality for persistent epistaxis. 3,5,6,8,[15][16][17] Factors that were independently associated with most of the five patients who required revision surgery (Table 6) included hypertension, antiplatelet therapy, previous sphenopalatine artery ligation, using clips only instead of diathermy during the first surgery, and alternative bleeding sources besides the sphenopalatine artery. Despite the lack of evidence for direct causality, these risk factors are consistent with those identified in previous studies, 15 and may be interpreted as predictors of procedural failure.…”