INTRACTABLE EPISTAXIS - TRANSANTRAL LIGATION VS EMBOLIZATION - EFFICACY REVIEW AND COST-ANALYSIS

After posterior nasal packing, the two most common therapies for intra ctable epistaxis are transantral ligation of the internal maxillary ar tery and percutaneous embolization of the distal internal maxillary ar tery. However, optimal management of intractable posterior epistaxis r emains controversial. We retrospectively reviewed the charts of 21 pat ients treated for intractable epistaxis and obtained data on presentat ion, risk factors, treatment, success rates, complications, and cost, Twelve patients received percutaneous embolization, five underwent tra nsantral ligation, and four required both, The success rates for trans antral ligation and percutaneous embolization were 89% and 94%, respec tively. No mortality or serious morbidity occurred with either techniq ue. A cost comparison revealed that transantral ligation was moderatel y less expensive than percutaneous embolization ($5941 vs, $6783). Alt hough some authors advocate transantral ligation or percutaneous embol ization as the procedure of choice for intractable epistaxis, a direct comparison of efficacy and cost reveals that they are comparable proc edures with specific strengths and weaknesses, We present our experien ce and a review of the literature, highlighting the indications and ad vantages of each technique, We conclude that the choice of treatment m odality should be based on the benefits of each procedure as it pertai ns to the specific needs of the individual patient.