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Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?

Published online by Cambridge University Press:  09 February 2017

A Ellinas ,
P Jervis ,
G Kenyon  and
L M Flood
A Ellinas
Affiliation:
ENT Department, Northampton General Hospital, UK
P Jervis
Affiliation:
ENT Department, Northampton General Hospital, UK
G Kenyon
Affiliation:
Department of Physiology, Development and Neuroscience, University of Cambridge, UK
L M Flood*
Affiliation:
ENT Department, James Cook University Hospital, Middlesbrough, UK
*
Address for correspondence: Mr Liam M Flood, ENT Department, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, UK E-mail: Liam.flood@nhs.net
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Abstract

Background:

Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention.

Objectives:

This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.

Keywords

EpistaxisEndoscopySurgeryLigation
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 4 , April 2017 , pp. 290 - 297
Copyright
Copyright © JLO (1984) Limited 2017 

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References

1 Khan, MK, Reda El Badawey, M, Powell, J, Idris, M. The utility of FloSeal haemostatic agent in the management of epistaxis. J Laryngol Otol 2015;129:353–7Google Scholar
2 White, PS. Endoscopic ligation of the sphenopalatine artery (ELSA): a preliminary description. J Laryngol Otol 1996;110:27–30 CrossRefGoogle Scholar
3 Malcomson, KG. The surgical management of massive epistaxis. J Laryngol Otol 1963;77:299–314 CrossRefGoogle ScholarPubMed
4 Budrovich, R, Saetti, R. Microscopic and endoscopic ligature of the sphenopalatine artery. Laryngoscope 1992;102:1391–4CrossRefGoogle ScholarPubMed
5 Sharp, HR, Rowe-Jones, JM, Biring, GS, Mackay, IS. Endoscopic ligation or diathermy of the sphenopalatine artery in persistent epistaxis. J Laryngol Otol 1997;111:1047–50Google Scholar
6 Wormald, PJ, Wee, DT, van Hasselt, CA. Endoscopic ligation of the sphenopalatine artery for refractory posterior epistaxis. Am J Rhinol 2000;14:261–4Google Scholar
7 Kotecha, B, Fowler, S, Harkness, P, Walmsley, J, Brown, P, Topham, J. Management of epistaxis: a national survey. Ann R Coll Surg Engl 1996;78:444–6Google Scholar
8 Spielmann, PM, Barnes, ML, White, PS. Controversies in the specialist management of adult epistaxis: an evidence-based review. Clin Otolaryngol 2012;37:382–9Google Scholar
9 Hall, AC, Simons, M, Pilgrim, G, Theokli, C, Roberts, D, Hopkins, C. Epistaxis management at Guy's Hospital, 2009–2011: full audit cycles. J Laryngol Otol 2014;128:82–5CrossRefGoogle ScholarPubMed
10 Hall, AC, Blanchford, H, Chatrath, P, Hopkins, C. A multi-centre audit of epistaxis management in England: is there a case for a national review of practice? J Laryngol Otol 2015;129:454–7Google Scholar
11 Syed, I, Sunkaraneni, VS. Evidence-based management of epistaxis in hereditary haemorrhagic telangiectasia. J Laryngol Otol 2015;129:410–15Google Scholar
12 Dedhia, RC, Desai, SS, Smith, KJ, Lee, S, Schaitkin, BM, Snyderman, CH et al. Cost-effectiveness of endoscopic sphenopalatine artery ligation versus nasal packing as first-line treatment for posterior epistaxis. Int Forum Allergy Rhinol 2013;3:563–6Google Scholar
13 McDermott, AM, O'Cathain, E, Carey, BW, O'Sullivan, P, Sheahan, P. Sphenopalatine artery ligation for epistaxis: factors influencing outcome and impact of timing of surgery. Otolaryngol Head Neck Surg 2015;154:547–52Google Scholar
14 Walen, SG, Rudmik, LR, Lipkewitch, S, Dixon, E, Mechor, B. Training, practice, and referral patterns in rhinologic surgery: survey of otolaryngologists. J Otolaryngol Head Neck Surg 2010;39:297–303 Google Scholar
15 Feusi, B, Holzmann, D, Steurer, J. Posterior epistaxis: systematic review on the effectiveness of surgical therapies. Rhinology 2005;43:300–4Google Scholar
16 Kumar, S, Shetty, A, Rockey, J, Nilssen, E. Contemporary surgical treatment of epistaxis. What is the evidence for sphenopalatine artery ligation? Clin Otolaryngol Allied Sci 2003;28:360–3CrossRefGoogle ScholarPubMed
17 Aval, S, Pabla, L, Flood, LM. The National Institute for Health and Clinical Excellence, and otolaryngology: review of the evidence. J Laryngol Otol 2014;128:2–12 Google Scholar
18 Rockey, JG, Anand, R. A critical audit of the surgical management of intractable epistaxis using sphenopalatine artery ligation/diathermy. Rhinology 2002;40:147–9Google ScholarPubMed
19 National Institute for Health Research. PROSPERO: International prospective register of systematic reviews. In: www.crd.york.ac.uk/PROSPERO/ [19 January 2017]Google Scholar
20 McClurg, SW, Carrau, R. Endoscopic management of posterior epistaxis: a review. Acta Otorhinolaryngol Ital 2014;34:1–8 Google ScholarPubMed
21 Loughran, S, Hilmi, O, McGarry, GW. Endoscopic sphenopalatine artery ligation--when, why and how to do it. An on-line video tutorial. Clin Otolaryngol 2005;30:539–43Google Scholar
22 Cooper, SE, Ramakrishnan, VR. Direct cauterization of the nasal septal artery for epistaxis. Laryngoscope 2012;122:738–40Google Scholar
23 Daudia, A, Jaiswal, V, Jones, N. Guidelines for the management of idiopathic epistaxis in adults: how we do it. Clin Otolaryngol 2008;33:618–20CrossRefGoogle ScholarPubMed
24 Moshaver, A, Harris, JR, Liu, R, Diamond, C, Seikaly, H. Early operative intervention versus conventional treatment in epistaxis: randomized prospective trial. J Otolaryngol 2004;33:185–8Google Scholar
25 Cassano, M, Marioni, G, Russo, L, Cassano, P. Sphenopalatine artery ligation with nerve resection in patients with vasomotor rhinitis and polyposis: a prospective, randomized, double-blind investigation. Acta Otolaryngol 2012;132:525–32CrossRefGoogle ScholarPubMed
26 Cassano, M, Russo, L, Del Giudice, AM, Gelardi, M. Cytologic alterations in nasal mucosa after sphenopalatine artery ligation in patients with vasomotor rhinitis. Am J Rhinol Allergy 2012;26:49–54 Google Scholar
27 Cassano, M, Cassano, P. Epistaxis after partial middle turbinectomy: the role of sphenopalatine artery ligation. Am J Otolaryngol 2012;33:116–20Google Scholar
28 Asanau, A, Timoshenko, AP, Vercherin, P, Martin, C, Prades, JM. Sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis. Ann Otol Rhinol Laryngol 2009;118:639–44Google Scholar
29 Holzmann, D, Kaufmann, T, Pedrini, P, Valavanis, A. Posterior epistaxis: endonasal exposure and occlusion of the branches of the sphenopalatine artery. Eur Arch Otorhinolaryngol 2003;260:425–8CrossRefGoogle ScholarPubMed
30 Umapathy, N, Quadri, A, Skinner, DW. Persistent epistaxis: what is the best practice? Rhinology 2005;43:305–8Google Scholar
31 Nouraei, SA, Maani, T, Hajioff, D, Saleh, HA, Mackay, IS. Outcome of endoscopic sphenopalatine artery occlusion for intractable epistaxis: a 10-year experience. Laryngoscope 2007;117:1452–6Google Scholar
32 Cassano, M, Longo, M, Fiocca-Matthews, E, Del Giudice, AM. Endoscopic intraoperative control of epistaxis in nasal surgery. Auris Nasus Larynx 2010;37:178–84Google Scholar
33 Lakhani, R, Syed, I, Qureishi, A, Bleach, N. The Wexham Criteria: defining severe epistaxis to select patients requiring sphenopalatine artery ligation. Eur Arch Otorhinolaryngol 2013;270:2039–43CrossRefGoogle ScholarPubMed
34 Abdelkader, M, Leong, SC, White, PS. Endoscopic control of the sphenopalatine artery for epistaxis: long-term results. J Laryngol Otol 2007;121:759–62Google Scholar
35 Gede, LL, Aanaes, K, Collatz, H, Larsen, PL, von Buchwald, C. National long-lasting effect of endonasal endoscopic sphenopalatine artery clipping for epistaxis. Acta Otolaryngol 2013;133:744–8Google Scholar
36 George, A, Smatanova, K, Joshi, H, Jervis, S, Oluwole, M. Sphenopalatine, anterior ethmoid and internal maxillary artery intervention in the management of refractory epistaxis: their efficacy in 25 patients. Clin Otolaryngol 2012;37:321–5CrossRefGoogle ScholarPubMed
37 Howe, DJ, Wazir, U, Skinner, DW. Outcomes of endoscopic sphenopalatine artery ligation for epistaxis: a five-year series from a single institution. Ear Nose Throat J 2012;91:70–2Google Scholar
38 Eladl, HM, Elmorsy, SM, Khafagy, YW. Endoscopic devascularisation of sphenopalatine bundle in intractable posterior epistaxis: technique, efficacy and safety. J Laryngol Otol 2011;125:1136–40Google Scholar
39 Srinivasan, V, Sherman, IW, O'Sullivan, G. Surgical management of intractable epistaxis: audit of results. J Laryngol Otol 2000;114:697–700 CrossRefGoogle ScholarPubMed
40 Yung, M, Sharma, R, Jablenska, L, Yung, T. A 2-cycle audit on the feasibility, efficacy and patient acceptance of 21 emergency sphenopalatine artery ligations under local anaesthesia: our experience. Clin Otolaryngol 2016;41:407–11Google Scholar
41 Rudmik, L, Leung, R. Cost-effectiveness analysis of endoscopic sphenopalatine artery ligation vs arterial embolization for intractable epistaxis. JAMA Otolaryngol Head Neck Surg 2014;140:802–8Google Scholar
42 Miller, TR, Stevens, ES, Orlandi, RR. Economic analysis of the treatment of posterior epistaxis. Am J Rhinol 2005;19:79–82 CrossRefGoogle ScholarPubMed
43 Leung, RM, Smith, TL, Rudmik, L. Developing a laddered algorithm for the management of intractable epistaxis: a risk analysis. JAMA Otolaryngol Head Neck Surg 2015;141:405–9Google Scholar
44 Shires, CB, Boughter, JD, Sebelik, ME. Sphenopalatine artery ligation: a cadaver anatomic study. Otolaryngol Head Neck Surg 2011;145:494–7Google Scholar
45 Simmen, DB, Raghavan, U, Briner, HR, Manestar, M, Groscurth, P, Jones, NS. The anatomy of the sphenopalatine artery for the endoscopic sinus surgeon. Am J Rhinol 2006;20:502–5Google Scholar
46 Antunes Scanavini, AB, Navarro, JA, Megale, SR, Lima, RS, Anselmo-Lima, WT. Morphometric evaluation of the sphenopalatine foramen for endonasal surgery. Rhinology 2010;48:441–5CrossRefGoogle ScholarPubMed
47 Midilli, R, Orhan, M, Saylam, CY, Akyildiz, S, Gode, S, Karci, B. Anatomic variations of sphenopalatine artery and minimally invasive surgical cauterization procedure. Am J Rhinol Allergy 2009;23:38–41 Google Scholar
48 Schwartzbauer, HR, Shete, M, Tami, TA. Endoscopic anatomy of the sphenopalatine and posterior nasal arteries: implications for the endoscopic management of epistaxis. Am J Rhinol 2003;17:63–6Google Scholar
49 Nalavenkata, S, Meller, C, Novakovic, D, Forer, M, Patel, NP. Sphenopalatine foramen: endoscopic approach with bony landmarks. J Laryngol Otol 2015;129(suppl 3):S47–52Google Scholar
50 Biswas, D, Ross, SK, Sama, A, Thomas, A. Non-sphenopalatine dominant arterial supply of the nasal cavity: an unusual anatomical variation. J Laryngol Otol 2009;123:689–91Google Scholar
51 Jonas, N, Viani, L, Walsh, M. Sphenopalatine artery ligation under local anesthesia: a report of two cases and review of the literature. Local Reg Anesth 2010;3:1–4 Google Scholar
52 Elsheikh, E, El-Anwar, MW. Septal perforation and bilateral partial middle turbinate necrosis after bilateral sphenopalatine artery ligation. J Laryngol Otol 2013;127:1025–7Google Scholar
53 Moorthy, R, Anand, R, Prior, M, Scott, PM. Inferior turbinate necrosis following endoscopic sphenopalatine artery ligation. Otolaryngol Head Neck Surg 2003;129:159–60Google Scholar
54 Adam, S, Sama, HD, Chossegros, C, Bedrune, B, Chesnier, I, Pradier, JP. Iatrogenic palatine necrosis by embolization of sphenopalatine arteries during management of epistaxis [in French]. Rev Stomatol Chir Maxillofac Chir Orale 2015;116:170–2Google Scholar