Treatment of Recurrent Epistaxis by Artery Ligation: Up to Date or Old Fashioned?

Background: Despite the ongoing development in the field of endoscopic treatment techniques, recurrent epistaxis remains a challenge for otolaryngologists. The aim of the present study was to compare our own results of various interventions for the treatment of recurrent epistaxis. Materials and Methods: From 2007 to 2013 we performed surgical treatment of recurrent epistaxis under general anaesthesia in 148 cases. While the majority of causes were idiopathic (n = 98), epistaxis also occurred postoperatively (n = 30), post-traumatically (n = 7) or as a result of M. Osler (n = 12). In 141/148 cases the treatment was performed by mono-or bipolar coagulation in the area of the bleeding source - this required an ethmoidectomy in 17 cases. In 19 cases the intervention was combined with a septoplasty. In 4 patients with recurrent bleeding of unknown origin, where electrocoagulation under general anaesthesia failed, we performed a clipping of the ethmoid- and/or the maxillary arteries in the pterygopalatine fossa. Following this intervention no further bleeding episodes occured. In further 3 patients, neuroradiological embolization was successfully performed. Conclusion: If conservative measures fail in the treatment of epistaxis, surgical treatment by electrocoagulation of the bleeding site under general anaesthesia is an effective intervention in 95 % of cases. However for the remaining 5 % where these measures have been proven to be ineffective, clipping of the ipsilateral anterior and posterior ethmoid-and/or the maxillar artery provides a treatment option being equally efficient as neuroradiological interventions.