Unilateral versus Bilateral SPA Ligation: Risk Factors and Outcomes following Treatment for Recurrent Epistaxis

Erratum: Special Virtual Symposium of the North American Skull Base Society

Background: Epistaxis affects up to 60 million people each year, with 6 to 10% needing medical attention. Although most cases are relatively minor and self-resolving, others are more severe requiring surgical intervention. With a purported success rate of between 85 and 100% in the literature, sphenopalatine artery (SPA) ligation poses a viable and historically successful option. There is, however, little to no published data both analyzing the risks factors believed to be responsible for rebleeding in patients undergoing SPA ligation and comparing the success rate of unilateral versus bilateral SPA ligation.

Objectives: To analyze risk factors responsible for rebleed and reasons why rebleeding occurred among those patients who failed SPA ligation, review previous literature on the success rates of unilateral versus bilateral SPA ligation, and present our findings.

Study Design: Retrospective chart review at a large academic center in a municipal city.

Subjects and Methods: A single-center, retrospective chart review from June 2015 to August 2020 of patients undergoing SPA ligation for epistaxis control was performed. A total of 195 patients were identified. Baseline demographic data, previous medical management, comorbidities, risk factors, and anticoagulation status were collected. Descriptive statistics, along with a Chi-square test and Fischer's test, were used for data analysis via SPSS 26. Significant and near-significant findings were analyzed using multivariate analysis.

Results: A total of 195 patients underwent SPA ligation, with 118 undergoing unilateral SPA ligation and 77 undergoing bilateral SPA ligation. Of the 118 unilateral SPA ligations, 14 had rebleeding within 30 days. Of the 77 undergoing bilateral SPA ligations, 15 had rebleeding within 30 days. Patients with the following risk factors were significantly more likely to rebleed: history of pulmonary embolism (p < 0.01), history of deep vein thrombosis (p < 0.01), and history of clotting disorder (p = 0.038). History of smoking (p = 0.474), cancer (p = 0.453), anticoagulation use (p = 0.443), hypertension (p = 0.672), diabetes mellitus (p = 0.206), obstructive sleep apnea (p = 0.510), hyperlipidemia (p = 0.863), anemia (p = 0.906), chronic obstructive pulmonary disease (p = 0.135), heart failure (p = 0.188), atrial fibrillation (p = 0.147), liver disease (p = 0.299), cocaine use (p = 0.162), heart valve replacement (p = 0.303), coronary artery disease (p = 0.282), and stent placement (p = 0.646) did not seem to pose a statistically significant increase in risk of rebleeding. History of chronic kidney disease (p = 0.066) trended toward significance. There was no significant difference between rate of re-bleeding when comparing bilateral versus unilateral SPA ligation (p = 0.348).

Conclusion: A history of pulmonary embolism, deep vein thrombosis, and clotting disorder increases the risk of SPA ligation failure and subsequent rebleeding. There does not appear to be a statistically significant difference in the number of rebleeds following unilateral versus bilateral SPA ligation.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021