Comparison of internal maxillary artery ligation versus embolization for refractory posterior epistaxis☆,☆☆,★

Presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, Washington, D.C., Sept. 29–Oct. 2, 1996.
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Abstract

OBJECTIVE: This study examined the advantages and disadvantages of internal maxillary artery (IMA) ligation versus embolization for the treatment of refractory posterior epistaxis.

METHODS: Thirty-nine patients underwent 42 procedures for treatment of posterior epistaxis at the University of Cincinnati Medical Center between 1986 and 1994. Complication rates, failure rates, demographics, and the costs of IMA ligation and embolization were compared. A review of 20 studies published between 1973 and 1995 was done to determine the complication and failure rates of IMA ligation and embolization. Finally, a mail survey was used to determine the availability and use of IMA ligation and embolization by urban and rural otolaryngologists in Ohio.

RESULTS: Complication and failure rates of IMA ligation and embolization were similar at our institution. In the literature review, IMA ligation had a higher complication rate, but fewer failures. Although the major complication rates were not significantly different, those associated with embolization were often more serious than those associated with IMA ligation. At our institution, the cost of IMA embolization was significantly lower than the cost of IMA ligation. Only 11% of Ohio otolaryngologists in nonurban areas have embolization available to treat posterior epistaxis.

CONCLUSION: IMA ligation is more effective than IMA embolization but may be associated with a higher minor complication rate. The major complications that occur with IMA embolization are often more serious. Although IMA embolization was less expensive at our institution, it is unavailable in most nonurban regions in Ohio. Training in the use of IMA ligation for refractory posterior epistaxis should continue in otolaryngology residency training programs despite the increasing availability of embolization at university training centers. (Otolaryngol Head Neck Surg 1998;118:636-42.)

Section snippets

Retrospective Review

The medical records of patients treated for refractory posterior epistaxis between 1987 and 1994 were reviewed in accordance with the policies of the local institutional review board. Complete medical records were available for 39 patients who underwent 44 procedures; 28 patients underwent 33 embolizations, and 11 patients underwent 11 ligations. Six of the 11 patients who had ligation also underwent concurrent ligation of one or both ethmoid arteries. In all ligation cases, a standard

RESULTS

There appeared to be an increasing use of embolizations at the University of Cincinnati in every year except 1987 and 1991 (Fig. 1).

. Bar graph demonstrates that use of IMA embolization for managing refractory posterior epistaxis at University of Cincinnati has increased between 1987 and 1993.

There was no significant difference in which side (right or left) was embolized or ligated. The average ages of the patients who underwent embolization (55.7 years, range 20 to 96 years) and of the patients

DISCUSSION

The first IMA ligation for posterior epistaxis was described by Sieffert4 in 1928 and the procedure was reintroduced by Chandler and Serrins5 in 1965 and popularized by Montgomery in the 1970s. IMA embolization for posterior epistaxis was first described by Sokoloff et al.6 in 1974 and has been used at the University of Cincinnati Medical Center since the mid-1980s. In the spring of 1994, the otolaryngology residents and staff at our institution noted a general increase in IMA embolizations and

CONCLUSIONS

  • 1.

    IMA ligation is more effective than IMA embolization in the treatment of refractory posterior epistaxis. IMA ligation is associated with a higher minor complication rate, but is associated with a major complication rate similar to that for IMA embolization. The types of major complications associated with IMA embolization are more serious than those for surgical ligation.

  • 2.

    Although IMA embolization is a less expensive alternative, its associated higher failure rate and association with more

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    • Cited by (0)

    ☆

    From the Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati Medical Center.

    ☆☆

    Reprint requests: Thomas A. Tami, MD, Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati Medical Center, 231 Bethesda Ave., P.O. Box 670528, Cincinnati, OH 45267.

    ★

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    Copyright © 1998 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. Published by Mosby, Inc. All rights reserved.