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

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Abstract

Transnasal endoscopic sphenopalatine artery occlusion procedures are becoming the standard of care for intractable posterior epistaxis. Improved endoscopic anatomical features of the lateral nasal wall and endoscopic skill with high-resolution cameras result in a higher success rate of endoscopic intervention. To evaluate the safety and effectiveness of endoscopic cauterization of the sphenopalatine artery (ESPAC) in controlling intractable posterior nasal bleeding. This prospective cohort study enrolled patients with refractory posterior epistaxis from August 2016 to December 2019. The trial recruited patients between 18 and 65 years of age with a history of recurrent and refractory posterior epistaxis receiving endoscopic arterial cauterization due to conservative treatment failure. All of the cases involved bipolar cauterization. Recurrent nosebleeds must pause for at least three months for a procedure to be considered successful. In the first 30 days following surgery, complications are recorded. 415 patients with epistaxis received both inpatient and outpatient care. Transnasal ESPAC was necessary for 36 patients (11.5%). The most common comorbidity was hypertension accounting for 9 (23%) cases. Thus, 26 of 36 (72%) cases had a unilateral ESPAC, while 10 (28%) had a bilateral ESPAC. Twenty-two (61%) and ten (28%) patients had single and two branching patterns of the sphenopalatine artery, respectively. Septal correction and middle meatus antrostomy (44%) were the most performed additional procedures. During the three-month follow-up period, 35 patients in this study had epistaxis control; the success rate of ESPAC was 97.2%. There were no significant postoperative complications found. Endoscopic sphenopalatine artery cauterization is successful in controlling 97.2% of posterior epistaxis. It is safe and effective without any significant complications.

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Acknowledgements

We are grateful to Dr. F. Anthony Irudhayarajan of the Department of Otorhinolaryngology, Upgraded Institute of Otolaryngology, Rajiv Gandhi Government General Hospital in Chennai, for his guidance.

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Authors and Affiliations

  1. Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, 600003, India

    Karthik Sundarajan & Karthiga Arumugam

  2. Department of Head and Neck Surgery, CMC, Vellore, India

    Suresh Mani

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  1. Karthik Sundarajan
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KS, SM and KA: Concepts, design, definition of intellectual content, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review. KS and KA: Clinical studies, Guarantor. SM and KA: Literature search

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Correspondence to Karthiga Arumugam.

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Sundarajan, K., Mani, S. & Arumugam, K. Management of Recurrent and Refractory Posterior Epistaxis by Transnasal Endoscopic Sphenopalatine Artery Cauterization: a Prospective Cohort Study. Indian J Otolaryngol Head Neck Surg 75, 2792–2797 (2023). https://doi.org/10.1007/s12070-023-03793-3

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