Superselective Unilateral Embolization of the Sphenopalatine Artery for Severe Posterior Epistaxis: A Prospective Study on the Safety and Efficacy

Objectives: Epistaxis is a common condition affecting up to 60% of the population, with approximately 6% requiring medical intervention. Posterior epistaxis is particularly challenging, often necessitating endoscopic or endovascular treatment. Sphenopalatine artery (SPA) embolization is an effective treatment option, though concerns remain about the risks associated with nonselective or bilateral approaches. This study evaluates the efficacy and safety of unilateral superselective SPA embolization in managing severe posterior epistaxis. Methods: A prospective study of patients undergoing unilateral superselective SPA embolization for refractory posterior epistaxis over a four-year period was conducted. Demographic data, clinical history, prior treatments, and procedural characteristics were analyzed. The primary endpoint was clinical success, defined as the absence of recurrent bleeding within 24 h post-procedure. Secondary outcomes included recurrence at one month and complication rates. Results: Thirty-two patients with severe posterior epistaxis were included. All required nasal packing prior to embolization. Half had undergone previous endoscopic cauterization. Hypertension was present in 69%, and 56% were receiving anticoagulant or antiplatelet therapy. Clinical success was achieved in 100% of cases, with no rebleeding in the first 24 h. Two patients (6%) experienced early recurrence within seven days, requiring readmission. Minor complications included nasal dryness in two cases (6%); no major complications occurred. Mean fluoroscopy time was 19.9 ± 11 min. Conclusions: Unilateral superselective SPA embolization is a safe and highly effective treatment for severe posterior epistaxis, offering high initial success and low complication rates. Its adoption may reduce the need for bilateral procedures and surgical interventions.