Korean J Otorhinolaryngol-Head Neck Surg.  2016 May;59(5):366-372. 10.3342/kjorl-hns.2016.59.5.366.

Posterior Epistaxis: Risk Factors and Causes of Recurrence after Sphenopalatine Artery Ligation

• Lee HJ
• Cho HJ
• Joo YH
• Jeon SY
• Kim SW

• KMID: 2164350
• DOI: http://doi.org/10.3342/kjorl-hns.2016.59.5.366

Abstract

BACKGROUND AND OBJECTIVES
Most cases of epistaxis can be controlled by conservative management such electrocautery or nasal packing. However, for some cases of the posterior epistaxis, invasive procedures like endoscopic sphenopalatine artery ligation (SPAL) or arterial embolization are needed. In this study, risk factors present in patients who were hospitalized due to posterior epistaxis and postoperative complications and causes of recurrence after SPAL were analyzed.
SUBJECTS AND METHOD
A retrospective chart review of 75 patients who were admitted to Gyeongsang National University Hospital for the treatment of posterior epistaxis between 2009 and 2014 was performed. Demographic factors, seasonal variation, comorbid diseases, and laboratory results were analyzed. Furthermore, 35 patients who have undergone SPAL were surveyed by telephone regarding postoperative complications, and preoperative computerized tomography (CT) images were reviewed to figure out the causes of the recurrence after SPAL.
RESULTS
Among 75 patients, 53 (70.7%) were males. Male preponderance (80%) was more definite among those who have undergone SPAL (p=0.04). Age over 40 as well as the winter season and the underlying disease such as hypertension were also critical risk factors for posterior epistaxis. Four out of 35 patients who had undergone SPAL showed recurrence. The bleeding was detected in the branches of sphenopalatine artery in three out of the four patients who experienced recurrent bleeding following SPAL, which were controlled by revision surgery or arterial embolization.
CONCLUSION
Posterior epistaxis occurred frequently in men over 40 years of age and in winter. A careful preoperative review of CT images and meticulous dissection during SPAL might be helpful for preventing recurrence after SPAL.

Keyword

Arteries; Epistaxis; Ligation; Recurrence; Sphenopalatine

MeSH Terms

Arteries*
Demography
Electrocoagulation
Epistaxis*
Hemorrhage
Humans
Hypertension
Ligation*
Male
Methods
Postoperative Complications
Recurrence*
Retrospective Studies
Risk Factors*
Seasons
Telephone