title: Sphenopalatine Artery Ligation for Epistaxis: Factors Influencing Outcome and Impact of Timing of Surgery.
abstract: OBJECTIVE
  Sphenopalatine artery ligation is a commonly employed surgical intervention for control of posterior epistaxis unresponsive to nasal packing. The objective of the present study was to evaluate the outcome of sphenopalatine artery ligation for control of epistaxis at our institution and the impact of timing and other factors on outcome.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  Case notes were reviewed for 45 consecutive patients undergoing sphenopalatine artery ligation for control of epistaxis between October 2008 and October 2014.
  
  
  RESULTS
  Forty-one patients had nasal packing prior to sphenopalatine artery ligation, with 33 undergoing ≥2 packings. Postoperatively, 6 patients had rebleeding, which was treated with repacking (n = 4) and return to the operating room (n = 2). The overall success rate of sphenopalatine artery ligation was 87% (39 of 45). Rebleeding rate was not affected by concomitant septoplasty, anterior ethmoidal artery ligation, or postoperative nasal packing. Patients undergoing SPA ligation within the first 24 hours of admission had a significantly shorter hospital length of stay (3 vs 6 days, P = .02) and treatment cost (€5905 vs €10,001, P = .03). Length of stay was not influenced by sphenopalatine artery ligation after ≤1 nasal pack versus ≥2 packs. Timing of sphenopalatine artery ligation did not affect blood transfusion requirement (P = .84).
  
  
  CONCLUSIONS
  Sphenopalatine artery ligation is an effective management strategy for surgical control of refractory epistaxis. Early timing of sphenopalatine artery ligation may lead to reductions in length of stay.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Ailbhe M
authors.initials: AM
authors.lastname: McDermott
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Eadaoin
authors.initials: E
authors.lastname: O'Cathain
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Brian William
authors.initials: BW
authors.lastname: Carey
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Peter
authors.initials: P
authors.lastname: O'Sullivan
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland Sheahan.patrick@sivuh.ie.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheahan
mesh_terms: D004844:Epistaxis / Q000601:surgery*; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008438:Maxillary Artery / Q000601:surgery*; D008875:Middle Aged; D010159:Palate / Q000098:blood supply*; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome
keywords: epistaxis; nasal endoscopy; nasal packing; sphenopalatine artery ligation