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Surgical and interventional radiological management of adult epistaxis: systematic review

Published online by Cambridge University Press:  27 December 2017

C Swords ,
A Patel ,
M E Smith ,
R J Williams ,
I Kuhn  and
C Hopkins
C Swords*
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
A Patel
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
M E Smith
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
R J Williams
Affiliation:
Institute of Naval Medicine, Gosport, UK
I Kuhn
Affiliation:
University of Cambridge School of Clinical Medicine, UK
C Hopkins
Affiliation:
Department of Otolaryngology, Guy's and St Thomas’ Hospital, London, UK
*
Address for correspondence: Miss Chloe Swords, Department of Otolaryngology, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK E-mail: chloeswords@doctors.org.uk
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Abstract

Background:

There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery.

Method:

A systematic review of the literature was performed using a standardised published methodology and custom database search strategy.

Results:

Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73–100 per cent and 75–92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1–1.5 per cent). No articles directly compared the two techniques.

Conclusion:

Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.

Keywords

EpistaxisSurgical ProceduresOperativeRadiologyInterventionalLigation
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 12 , December 2017 , pp. 1108 - 1130
Copyright
Copyright © JLO (1984) Limited 2017 

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