TITLE:
Analysis of Endoscopic Sphenopalatine Artery Surgery for Refractory Epistaxis
AUTHORS:
Takahiro Kitamura, Yukinori Takenaka, Kengo Aoki, Takuma Shimada, Hiroko Hamaguchi, Ayaka Nakatani, Masayuki Nozawa, Ryohei Oya, Yoshifumi Yamamoto, Atsuhiko Uno
KEYWORDS:
Epistaxis, Sphenopalatine Artery, Emergency, Admission, Cauterization, Ligation, Endoscope
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.9 No.2,
March
9,
2020
ABSTRACT: Background: This study aimed to determine the safety and efficacy of sphenopalatine artery (SPA) surgery in patients with refractory epistaxis and to identify factors associated with the indications for surgery to assist clinicians in making prompt and appropriate decisions regarding SPA surgery for refractory epistaxis. Methods: We analyzed 97 consecutive patients with nasal bleeding hospitalized in our institution between April 2009 and March 2018. Clinicopathological characteristics and clinical outcomes were analyzed from retrospective chart reviews. Results: Of the 97 patients, 28 (29 sides) required SPA surgery. There were no differences in sex, anti-coagulant drug or antiplatelet use, hemoglobin concentration, or platelet count between Group A (patients who required surgery) and Group B (patients who did not require surgery). Age (58 vs. 67 years, p = 0.038) and severity of comorbidity (0 vs. 1, p = 0.039) were significantly lower in the surgery group. Patients who were younger and had lower Charlson Comorbidity Index (CCI) scores had more requirements for surgery than those who were older and had higher CCI scores. There was no significant difference between the groups with respect to the proportion of patients receiving blood transfusions; however, the length of hospitalization was significantly longer in Group A than in Group B (8.9 vs. 8 days, p = 0.038). Success rate (non-rebleeding rate) was 89%, comparable to that reported in previous studies. Conclusions: Endoscopic SPA surgery was found safe and effective method with few complications. Younger patients with lower CCI scores were found appropriate for SPA surgery for refractory epistaxis due in part to a lower risk of anesthesia.