Transnasal Endoscopic Sphenopalatine Artery Ligation Compared With Embolization for Intractable Epistaxis: A Long-term Analysis

Abstract

Background Transnasal endoscopic sphenopalatine artery ligation (TESPAL) and selective embolization both provide excellent treatment success rate in the management of intractable epistaxis. Few long-term studies comparing these approaches have been previously published. Recommendations often present these techniques as alternatives, but there is no clear consensus. Objective The purpose of this study was to evaluate and compare the clinical efficacy of sphenopalatine artery ligation versus embolization to control intractable epistaxis. Methods We performed a retrospective study including all patients referred to our tertiary medical center for severe epistaxis and treated by surgical ligation and/or embolization. The patients were classified into 2 groups: those who underwent TESPAL only and those who underwent endovascular embolization only. We evaluate and compare long-term clinical outcomes after surgical ligation or embolization for the control of intractable epistaxis in terms of effectiveness (recurrence rate) and safety (complication rate). Results Forty-one procedures of supraselective embolization and 39 procedures of surgical ligation for intractable epistaxis are reported and analyzed. No significant difference was observed between the groups in terms of demographic factors, comorbidities, or average length of hospital stay. The 1-year success rate was similar (75%) in both groups. Complications (minor and/or major) occurred in 34% cases in the embolization group and in 18% in the surgical group ( P = .09, ns). Bilateral embolization including facial artery was the only treatment method associated with a significant risk of complications ( P = .015). Conclusion TESPAL seems to provide a similar control rate with a decrease in the number of complications compared to selective embolization in the context of intractable epistaxis. Further studies are required.

Deep Learning-Based Analysis of Efficiency and Surgical Timing for Patients with Cervical Insufficiency Using Transvaginal Ultrasound Images

“…e result was consistent with the results reported by McDermott et al [14] that CC for CIC was superior to vaginal progesterone in increasing the survival rate of newborns. It suggested that the optimal time to perform CC was in 14-18 weeks of gestational age [15]. Among the patients under investigation, in the observation group, 40 patients in group A were treated with CC before 17 weeks, 36 patients were successfully treated with a success rate of 89.6%, and 4 patients failed with a failure rate of 10.4%; in group B, 27 patients were treated with CC after 17 weeks, 19 patients were successfully treated with a success rate of 70.4%, and 8 patients failed with a failure rate of 29.6%.…”

Pseudoaneurisma de artéria esfenopalatina após agressão por arma de fogo em face

“…Se persistir hemorragia após trauma facial a intervenção precoce com métodos de imagem como a tomografia computadorizada e angiografia é recomendada, para o estudo de uma possível embolização vascular (Lee et al, 2009;Bonnecaze et al 2018;Chun et al, 2019). Nesse relato, a angiografia não foi realizada imediatamente, porque os tamponamentos nasais foram eficazes para cessar o sangramento no momento inicial.…”

Endoscopic Sphenopalatine Artery Ligation in Posterior Epistaxis

“…The ligation reduces the discomfort, cost and potential medical morbidity compared to nasal packing. 11,12,13,14,15,16 This procedure was first described by Prades J. 17 Endoscopic SPA ligation was first described by Budrovich and saetti in 1992.…”