Persisting bleeding—surgical measures
In the UK it is generally regarded as reasonable to repack the nose on at least one occasion before resorting to alternative methods of control of epistaxis. This may lead to a patient spending a week or more in hospital with the nose packed for the majority of the time. Although this is a respectable way to manage the situation, and often attended by complete resolution of bleeding at the end, it is inevitable that the patient and the patient’s family will begin to feel that ‘nothing is being done’. When it is clear that a persisting haemorrhage is not being controlled by packing, and if there is no other medical factor which can be controlled, then the surgeon must consider tying off an artery (arterial ligation). The purpose of arterial ligation is to control part of the blood supply to the nose in such a way as to reduce the pressure within all the blood vessels of the nose temporarily, while the bleeding vessel has the opportunity to seal itself off.