title: Management of intractable spontaneous epistaxis.
abstract: BACKGROUND
  Epistaxis is a common otolaryngology emergency and is often controlled with first-line interventions such as cautery, hemostatic agents, or anterior nasal packing. A subset of patients will continue to bleed and require more aggressive therapy.
  
  
  METHODS
  Intractable spontaneous epistaxis was traditionally managed with posterior nasal packing and prolonged hospital admission. In an effort to reduce patient morbidity and shorten hospital stay, surgical and endovascular techniques have gained popularity. A literature review was conducted.
  
  
  RESULTS
  Transnasal endoscopic sphenopalatine artery ligation and arterial embolization provide excellent control rates but the decision to choose one over the other can be challenging. The role of transnasal endoscopic anterior ethmoid artery ligation is unclear but may be  considered in certain cases when bleeding localizes to the ethmoid region.
  
  
  CONCLUSIONS
  This article will focus on the management of intractable spontaneous epistaxis and discuss the role of endoscopic arterial ligation and embolization as it pertains to this challenging  clinical scenario.
authors.affiliation: Rhinology and Sinus Surgery, Division of Otolaryngology, Department of Surgery, University of Calgary, Alberta, Canada.
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D019468:Disease Management; D004621:Embolization, Therapeutic; D004724:Endoscopy; D004844:Epistaxis / Q000473:pathology / Q000601:surgery*; D005005:Ethmoid Sinus / Q000473:pathology; D006801:Humans; D008026:Ligation; D008438:Maxillary Artery / Q000473:pathology / Q000601:surgery*; D013101:Sphenoid Sinus / Q000473:pathology*; D016896:Treatment Outcome