A critical audit of the surgical management of intractable epistaxis using sphenopalatine artery ligation/diathermy.

An audit of the local practice of sphenopalatine artery (SPA) ligation/diathermy was undertaken following its introduction to the unit in April 1998. The authors looked to the literature for evidence of what was to be taken as a successful result and were surprised at the lack of published data on its efficacy or lack thereof. Fivehundredsixtythree patients were admitted for inpatient management of epistaxis over a two-year period. Ten of these patients required surgical control of epistaxis and went on to have either sphenopalatine artery ligation or diathermy. One had concomitant anterior ethmoidal artery diathermy. Postoperatively, the patients stayed between one to ten days (mean 3.3 days). The mean follow up in the clinic was 42.7 days. A recurrent bleed rate of 33% was found, which is higher than previously published results. Of these failures one had internal maxillary embolization followed by anterior ethmoidal artery ligation. The other two failures were successfully corrected with anterior ethmoidal ligation. The authors discuss and illustrate the possible reasons for failure.