title: Endoscopic cauterization of the sphenopalatine artery to control severe and recurrent posterior epistaxis.
abstract: BACKGROUND
  Epistaxis is one of the most common medical emergencies, making the management of posterior epistaxis a challenging problem for the ear, nose, and throat (ENT) surgeon. In the cases of conservative management failure, ligation of the major arteries or percutaneous embolization of the maxillary artery is performed routinely in most units, but rates of failure and complications are high. The objective of this study was to assess the effectiveness of endoscopic sphenopalatine artery (SPA) cauterization in patients with refractory posterior epistaxis.
  
  
  METHODS
  Between April 2011 and January 2012, 27 patients (15 males and 12 females) with refractory posterior epistaxis underwent endoscopic SPA cauterization in two tertiary referral hospitals in Shiraz. Three patients underwent bilateral cauterization.
  
  
  RESULTS
  Four patients (from 30 arteries) had new epistaxis after surgery, three experienced subsequent epistaxis requiring medical treatment, and one patient had a minor epistaxis not needing treatment.
  
  
  CONCLUSIONS
  The SPA electrocoagulation technique seems to be safe, simple, fast, and effective with low rates of morbidity and complications for the management of refractory posterior epistaxis. Endoscopic SPA cauterization should be considered as an immediate second-line management when conservative treatment as first-line management fails.
authors.affiliation: Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran .
authors.forename: Behrooz
authors.initials: B
authors.lastname: Gandomi
authors.forename: Mohammad Hosein
authors.initials: MH
authors.lastname: Arzaghi
authors.forename: Bijan
authors.initials: B
authors.lastname: Khademi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rafatbakhsh
keywords: Endoscopic sphenopalatine artery cauterization; Epistaxis; SPA electrocoagulation technique