From the Research
Surgical management for recurrent epistaxis typically involves endoscopic sphenopalatine artery cauterization (ESPAC) as the primary recommended intervention when conservative measures have failed, with a success rate of 97.2% and no significant postoperative complications. This procedure targets the sphenopalatine artery, which is the main blood supply to the nasal cavity. The surgery is performed under general anesthesia, with the surgeon accessing the artery through an endoscopic approach via the nasal cavity 1.
Key Points to Consider
- Endoscopic sphenopalatine artery cauterization is a safe and effective procedure for controlling posterior epistaxis, with a high success rate and low complication rate 1.
- Alternative surgical options include anterior ethmoid artery ligation for bleeding from the anterior nasal cavity, or external carotid artery ligation for severe cases unresponsive to other treatments.
- Embolization performed by interventional radiology is another option, particularly for patients who cannot tolerate general anesthesia.
- These surgical interventions are typically considered after failure of conservative management including nasal packing, cauterization, and medical therapy.
Post-Operative Care
- Patients should expect overnight hospitalization following the procedure, with recovery typically taking 1-2 weeks.
- Post-operative care includes saline nasal sprays, avoiding strenuous activity for 2 weeks, and refraining from blood thinners when possible to reduce rebleeding risk.
- The most recent study on ESPAC found no significant postoperative complications, making it a safe and effective option for patients with recurrent epistaxis 1.
Comparison with Other Studies
- Previous studies have shown that endoscopic sphenopalatine artery ligation (ESPAL) is also an effective treatment for posterior epistaxis, with a success rate of 85-95% and low complication rates 2, 3, 4.
- However, the most recent study on ESPAC found a higher success rate and no significant postoperative complications, making it the preferred treatment option 1.