Contemporary surgical treatment of epistaxis. What is the evidence for sphenopalatine artery ligation?

Background: Severe epistaxis is a frequent emergency condition encountered by otolaryngologists and is often treated with nasal packing. In the event of failure surgical treatment is considered. We aimed to evaluate the efficacy of Nasal Packing (NP) and Endoscopic Sphenopalatine Artery Ligation (ESPAL) as treatment of severe epistaxis in terms of failures and recurrences including risk factors. Methodology: Retrospective descriptive study of patients with epistaxis treated with NP, admitted to an ENT department from 2011-2017. If initial treatment with NP failed, patients were considered for ESPAL. Results: An analysis of 511 patients was performed. All patients were treated with NP at the time of admission, and 14% of pa- tients were treated with ESPAL due to failure of NP. The majority of patients was only admitted once. Twelve percent were readmit- ted within 30 days, 7% were readmitted >30 days later. Treatment failure after ESPAL was 7.9%. No significant difference in the risk of readmission was found between patients treated with NP alone and patients treated with ESPAL. Conclusion: The majority of epistaxis patients were effectively treated with NP alone. We found good effect of ESPAL although no significant differences in risk of readmission NP vs. ESPAL were identified.

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Ligation of left pulmonary artery instead of patent ductus arteriosus

Cardiology in the Young ◽

10.1017/s1047951120002784 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1943-1945

Author(s):

Semih Murat Yucel ◽

Irfan Oguz Sahin

Keyword(s):

Surgical Treatment ◽

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Surgical Complication ◽

Ductus Arteriosus ◽

Left Pulmonary Artery ◽

Artery Ligation ◽

Surgical Closure ◽

Post Operative Period ◽

Patent Ductus

AbstractDuctus arteriosus is an essential component of fetal circulation. Due to occurring changes in the cardiopulmonary system physiology after birth, ductus arteriosus closes. Patent ductus arteriosus can be closed by medical or invasive (percutaneous or surgical) treatment methods. Percutaneous or surgical closure of patent ductus arteriosus can be performed for the cases that medical closure failed. Surgical treatment is often preferred method for closure of patent ductus arteriosus in the neonatal period. The most common surgical complications are pneumothorax, recurrent laryngeal nerve injury, bleeding, and recanalisation. A very rare surgical complication is left pulmonary artery ligation that has been presented in a few cases in the literature. Echocardiography control should be performed in the early post-operative period, especially in patients with clinical suspicion. If reoperation is required, it should never be delayed. We report a newborn patient whose left pulmonary artery ligated accidentally during patent ductus arteriosus closure surgery and surgical correction of this complication at the early post-operative period.

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Endoscopic Sphenopalatine Artery Ligation: General Applicability in a Teaching Unit

Ear Nose & Throat Journal ◽

10.1177/0145561319828675 ◽

2019 ◽

Vol 98 (2) ◽

pp. 85-88 ◽

Cited By ~ 2

Author(s):

Shi Ying Hey ◽

Nigel K. F. Koo Ng ◽

Gerald W. McGarry

Keyword(s):

Grade Level ◽

Teaching Hospitals ◽

Artery Ligation ◽

General Applicability ◽

Sphenopalatine Artery ◽

The United Kingdom ◽

Simulation Based ◽

Teaching Unit ◽

Competency Based ◽

Nose And Throat

Background: Endoscopic sphenopalatine artery ligation (ESPAL) is the intervention of choice for refractory epistaxis in specialist ear, nose and throat (ENT)units and should be within the repertoire of competencies for all ENT trainees. Following its recent incorporation within the United Kingdom competency–based training syllabus as an explicit outcome standard, the ESPAL is not uncommonly being delivered by trainees under appropriate supervision. We assessed the efficacy and outcome of ESPAL in epistaxis management within our teaching hospitals. Methods: Retrospective, structured review of all ESPAL procedures performed for epistaxis between December 2005 and December 2013. The techniques of ligation, operator grade, and outcome were studied. Results: Sixty-five patients (41 male:24 female; average age of 58.2 years) were identified in whom 67 artery ligations were performed (63 unilateral; 2 bilateral). Overall, success rate of ESPAL was 92.3% (60/65), with 5 rebleed cases recorded within 30 days of the primary procedure. Sixteen (24.6%) underwent “clipping,” 26 (40.0%) had diathermy ligation, 18 (27.7%) had both clipping and diathermy, and in 5 (7.7%) patients, the ligation technique was not recorded. In 31 (47.7%) of 65 cases, a consultant was the principal surgeon. The remaining 34 (52.3%) of 65 cases were performed by trainees with (24, 70.6%) or without (10, 29.4%) supervision. There was no correlation between rebleed and operators’ grade, level of supervision, or ligation technique. Conclusion: With appropriate training, ESPAL can achieve hemostasis in teams of varying grades of operators without significant reduction in outcome. To further enhance the technical learning curve, the utility of simulation-based training could offer continuous and longitudinal development of skills.

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Surgical treatment of post-partum haemorrhage: how to improve the results of hypogastric artery ligation

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2016.07.146 ◽

2016 ◽

Vol 206 ◽

pp. e48

Author(s):

A. Halouani ◽

M. Kehila ◽

S. Derouich ◽

O. Touhami ◽

M. Chemkhi ◽

...

Keyword(s):

Surgical Treatment ◽

Post Partum ◽

Hypogastric Artery ◽

Artery Ligation ◽

Post Partum Haemorrhage

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The Role of the Crista Ethmoidalis in Endoscopic Sphenopalatine Artery Ligation

American Journal of Rhinology ◽

10.2500/105065899782106814 ◽

1999 ◽

Vol 13 (2) ◽

pp. 81-86 ◽

Cited By ~ 36

Author(s):

William E. Bolger ◽

Roderick G. Borgie ◽

Patrick Melder

Keyword(s):

Artery Ligation ◽

Sphenopalatine Artery

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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

Journal of Nepal Medical Association ◽

10.31729/jnma.5855 ◽

2020 ◽

Vol 58 (232) ◽

Author(s):

Meenakshi Basnet ◽

Bibek Ghimire ◽

Akriti Shrestha ◽

Gyan Raj Aryal

Keyword(s):

Success Rate ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Medical Emergency ◽

Care Hospital ◽

Sectional Study ◽

Artery Ligation ◽

Cross Sectional ◽

Sphenopalatine Artery

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.

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