title: Sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis.
abstract: OBJECTIVE
  We describe the surgical treatment of severe epistaxis and evaluate the recurrence of bleeding in a nonrandomized retrospective trial.
  
  
  METHODS
  We performed a retrospective study comparing bilateral endoscopic ligation of the sphenopalatine artery alone (ELSPA) and bilateral endoscopic ligation of the sphenopalatine artery with concomitant bilateral external ligation of the anterior ethmoidal artery (ELSPEA) in the management of persistent epistaxis. Clinical and hematologic information, preoperative and surgical care, and short- and long-term outcomes were analyzed. The main outcome measure was recurrence of epistaxis in the short- and long-term follow-up periods.
  
  
  RESULTS
  Forty-five patients were enrolled in the study. There were 20 patients in group A (ELSPA) and 25 in group B (ELSPEA). Three patients in group A and no patients in group B had long-term (more than 2 weeks after surgery) rebleeding. The difference between the two groups was not statistically significant (p > 0.05).
  
  
  CONCLUSIONS
  We conclude that ELSPA and ELSPEA are effective, well-tolerated, reliable procedures if performed by an experienced surgeon. Their failure can be explained by anatomic lateral nasal wall variations and perioperative technical difficulties. They can be appropriate methods to treat severe recurrent epistaxis refractory to repeated nasal packing.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, North Hospital, Saint-Etienne University Hospital Center, Saint-Etienne, France.
authors.forename: Alexander
authors.initials: A
authors.lastname: Asanau
authors.forename: Andrei P
authors.initials: AP
authors.lastname: Timoshenko
authors.forename: Paul
authors.initials: P
authors.lastname: Vercherin
authors.forename: Christian
authors.initials: C
authors.lastname: Martin
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Prades
mesh_terms: D000368:Aged; D004724:Endoscopy; D004844:Epistaxis / Q000601:surgery*; D005005:Ethmoid Sinus / Q000098:blood supply*; D005260:Female; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D010159:Palate / Q000098:blood supply; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000098:blood supply*; D016896:Treatment Outcome