scholarly journals Changing Trends in the Management of Epistaxis

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Henri Traboulsi ◽  
Elie Alam ◽  
Usamah Hadi
Keyword(s):  
Family Physicians ◽  
Current Treatment ◽  
Nasal Packing ◽  
Treatment Modalities ◽  
Maxillary Artery ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
Changing Trends ◽  
Common Complaint ◽  
Different Types

Epistaxis is a very common complaint seen by many types of physicians including otolaryngologists, family physicians, and others. Management of epistaxis is often challenging and requires many types of intervention. The following review describes the different types of past and current treatment modalities including cautery, nasal packing, maxillary artery ligation, anterior artery ligation, and sphenopalatine artery ligation. The paper also proposes an algorithm for managing such cases.

scholarly journals Efficacy of Trans-nasal Endoscopic Sphenopalatine Artery Ligation in the Management of Recurrent Posterior Epistaxis

KYAMC Journal ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 133-137
Author(s):  
Muntasir Mahbub ◽  
Md Mahbubur Rahman
Keyword(s):  
Treatment Modalities ◽  
Recurrent Bleeding ◽  
Artery Ligation ◽  
Female Ratio ◽  
Bleeding Point ◽  
Sphenopalatine Artery ◽  
Recurrent Epistaxis ◽  
Nasal Bleeding ◽  
Endoscopic Ligation ◽  
Male To Female

Background: Recurrent posterior epistaxis is a challenging problem for most otolaryngologists. Of the several proposed treatment modalities, endoscopic ligation of SPA (Sphenopalatine artery) provides a simple and effective solution with relatively minor complications. Objectives: Aim of this study was to find out the success rate and complications of endoscopic ligation of SPA in the management of recurrent posterior epistaxis. Materials and Methods: This was an observational study conducted from Jan 2019 to Jan 2021. Total 60 patients were included in this study. Inclusion criteria were - recurrent epistaxis (at least 4 episodes in last 2 months) with bleeding point not seen in anterior rhinoscopy, Failure of previous conservative management with medications and nasal packing, age between 18–60 years of both sexes. All the patients underwent trans-nasal endoscopic Sphenopalatine artery ligation, and patients were followed up for 12 weeks to identify repeated bleeding and to evaluate complications. Results: In this study male to female ratio was 1.5:1. Mean age of study group was 44.66 (±8.62) years. No recurrent bleeding occurred in 51 (85%) and in 9 (15%) nasal bleeding occurred in the 2 months postoperative period. Anesthesia of incisor teeth occurred in 18 patients (30%), 22 patients (37%) complained about increased nasal crusting. Conclusion: Endoscopic ligation of Sphenopalatine artery shows good outcome in prevention of further episodes of epistaxis in most patients. Although some minor complications can occur, these are manageable. KYAMC Journal. 2021;12(3): 133-137

Cost-effectiveness of endoscopic sphenopalatine artery ligation versus nasal packing as first-line treatment for posterior epistaxis

2013 ◽  
Vol 3 (7) ◽  
pp. 563-566 ◽  
Author(s):  
Raj C. Dedhia ◽  
Shamit S. Desai ◽  
Kenneth J. Smith ◽  
Stella Lee ◽  
Barry M. Schaitkin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Nasal Packing ◽  
Line Treatment ◽  
First Line ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
First Line Treatment

scholarly journals Outcome of treatment for severe epistaxis: nasal packing and endoscopic sphenopalatine artery ligation

2021 ◽  
Vol 4 (4) ◽  
pp. 30-35
Author(s):  
J. Galili ◽  
M. Holm Nissen ◽  
T. Ovesen
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Descriptive Study ◽  
Nasal Packing ◽  
Good Effect ◽  
Artery Ligation ◽  
Sphenopalatine Artery ◽  
Significant Difference ◽  
Severe Epistaxis ◽  
Time Of Admission

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.

Arterial Ligation for Pediatric Epistaxis: Developmental Anatomy

2003 ◽  
Vol 17 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Glenn Isaacson ◽  
Janet M. Monge
Keyword(s):  
Maxillary Artery ◽  
Facial Growth ◽  
Arterial Ligation ◽  
Artery Ligation ◽  
Developmental Anatomy ◽  
Sphenopalatine Artery ◽  
Dental Eruption ◽  
Severe Epistaxis ◽  
Feeding Vessels ◽  
Ethmoidal Arteries

Background Anatomic studies of adult skulls have aided in the design of operations for the surgical ligation of nasal feeding vessels in the treatment of severe epistaxis. Lack of appropriate specimens has prevented similar studies in children. We performed an anthropometric study of archeological specimens to learn the effects of growth on key anatomic relationships. Methods We studied the skulls of children who died between 200 and 8000 years ago, recovered from archeological digs around the world. Measurements of the distances from the posterior lacrimal crest to the foramina of anterior and posterior ethmoidal arteries and optic canal and the pyriform aperture to the foramen of the sphenopalatine artery were made and compared with postnatal age, estimated from facial growth and dental eruption patterns. Results There is rapid growth in the orbit and midface during the first 6 years of life and gradual growth between 7 years and adulthood. The length of the medial wall of the orbit doubles during development with disproportionate enlargement of its anterior half. Conclusion Arterial ligation is sometimes required for intractable pediatric epistaxis, especially after trauma. The changing relationships of critical structures in the orbital must be understood to allow safe ethmoidal artery ligation. The transantral approach to the maxillary artery is greatly limited by lack of midfacial development and maxillary pneumatization. We describe the necessary parameters for endoscopic, transnasal sphenopalatine artery ligation in growing children.

The Use of Mesenchymal Stem Cells and their Derived Extracellular Vesicles in Cardiovascular Disease Treatment

2020 ◽  
Vol 15 (7) ◽  
pp. 623-638
Author(s):  
Saeideh Gholamzadeh Khoei ◽  
Fateme Karimi Dermani ◽  
Sara Malih ◽  
Nashmin Fayazi ◽  
Mohsen Sheykhhasan
Keyword(s):  
Cardiovascular Disease ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Extracellular Vesicles ◽  
Adult Stem Cells ◽  
Heart Diseases ◽  
Therapeutic Option ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Cellular Source

Background: Cardiovascular disease (CVD), including disorders of cardiac muscle and vascular, is the major cause of death globally. Many unsuccessful attempts have been made to intervene in the disease's pathogenesis and treatment. Stem cell-based therapies, as a regeneration strategy, cast a new hope for CVD treatment. One of the most well-known stem cells is mesenchymal stem cells (MSCs), classified as one of the adult stem cells and can be obtained from different tissues. These cells have superior properties, such as proliferation and highly specialized differentiation. On the other hand, they have the potential to modulate the immune system and anti-inflammatory activity. One of their most important features is the secreting the extracellular vesicles (EVs) like exosomes (EXOs) as an intercellular communication system mediating the different physiological and pathophysiological affairs. Methods: In this review study, the importance of MSC and its secretory exosomes for the treatment of heart disease has been together and specifically addressed and the use of these promising natural and accessible agents is predicted to replace the current treatment modalities even faster than we imagine. Results: MSC derived EXOs by providing a pro-regenerative condition allowing innate stem cells to repair damaged tissues successfully. As a result, MSCs are considered as the appropriate cellular source in regenerative medicine. In the plethora of experiments, MSCs and MSC-EXOs have been used for the treatment and regeneration of heart diseases and myocardial lesions. Conclusions: Administration of MSCs has been provided a replacement therapeutic option for heart regeneration, obtaining great attention among the basic researcher and the medical doctors.

scholarly journals Infective Aortic Valve Endocarditis Causing Embolic Consecutive ST-Elevation Myocardial Infarctions

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Kanksha Peddi ◽  
Alexander L. Hsu ◽  
Tomas H. Ayala
Keyword(s):  
Myocardial Infarction ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Index Case ◽  
Current Treatment ◽  
Myocardial Infarctions ◽  
Treatment Modalities ◽  
The Past ◽  
First Case ◽  
St Elevation

ST-elevation myocardial infarction (STEMI) is a rare and potentially fatal complication of infective endocarditis. We report the ninth case of embolic native aortic valve infective endocarditis causing STEMI and the first case to describe consecutive embolisms leading to infarctions of separate coronary territories. Through examination of this case in the context of the previous eight similar documented cases in the past, we find that infective endocarditis of the aortic valve can and frequently affect more than a single myocardial territory and can occur consecutively. Further, current treatment modalities for embolic infective endocarditis causing acute myocardial infarction are limited and unproven. This index case illustrates the potential severity of complications and the challenges in developing standardized management for such patients.

scholarly journals Endoscopic Sphenopalatine Artery Ligation: General Applicability in a Teaching Unit

2019 ◽  
Vol 98 (2) ◽  
pp. 85-88 ◽  
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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