Direct cauterization of the nasal septal artery for epistaxis

Abstract

Emergency management of epistaxis may include the use of local pressure and vasoconstrictors, chemical or electric cautery, hemostatic agents, nasal packing, embolization, and surgical arterial ligation. There is no definitive protocol for the management of epistaxis, although various protocols have been proposed in the literature. As approaches to surgical ligation of the arterial supply of the nasal cavity have evolved from external carotid ligation to minimally invasive approaches, surgical management of epistaxis has become more effective than embolization and may be less risky. In the surgical management of epistaxis, arterial ligation immediately proximal to the bleeding site is preferred. We propose a simple variation of the endoscopic sphenopalatine artery ligation that may be used to manage epistaxis arising from the nasal septum and floor.

Factors influencing recurrent emergency department visits for epistaxis in the elderly

“…Epistaxis is a common condition that rarely requires an ED visit [2]. A subset of patients that initially present with epistaxis to the ED develop recurrent epistaxis requiring readmission.…”

Early versus delayed treatment of primary epistaxis in the United States

“…Blood supply to this area is from the Kiesselbach plexus, which is comprised of second‐order branches of the internal and external carotid artery systems. Epistaxis originating from more posterior aspects of the nasal cavity accounts for only 5% to 10% of cases . Patients with posterior epistaxis often do not have resolution of their bleeding with nasal packing, with some series showing success rates as low as 48%.…”

“…Surgical intervention typically involves the use of open or endoscopic surgical approaches with direct cauterization or ligation of the involved artery . Reported success rates for surgical treatment of epistaxis are as high as 97% …”

Treatment disparities in the management of epistaxis in United States emergency departments

“…Topical cautery and hemostatic materials, nasal packing, endoscopic surgical ligation, and embolization procedures are among the range of options to treat mild‐ to life‐threatening epistaxis. Common practice and previously published algorithms suggest that a step‐wise and conservative approach is preferred over empiric nasal packing or surgical/interventional procedures …”

“…Common practice and previously published algorithms suggest that a step-wise and conservative approach is preferred over empiric nasal packing or surgical/interventional procedures. [3][4][5][6][7][8] Although prior studies have characterized demographic, seasonal, and geographic variation in epistaxis presentation throughout the United States, 9,10 there is a limited understanding of contemporary management patterns in the ED setting. 11 Indeed, as epistaxis management has evolved, so too has the landscape of emergency care.…”