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In Reply.—In the report cited above, a rare but serious complication of internal maxillary artery ligation was reported with a review of similar complications. Risk factors for posterior epistaxis include hypertension, advanced age, diabetes mellitus, and atherosclerotic vessel disease. In fact, some believe that atherosclerosis is the cause of most cases of posterior epistaxis. The aforementioned risk factors are also the risk factors for stroke when carotid angiography is performed. Our radiology department reports an overall stroke incidence of 0.5% to 1%. These patients would be at high risk not only for this complication in angiography but also for routine complications of allergic reactions and vessel perforation.
We believe that all invasive procedures, including posterior nasal packing, are associated with significant risk. Risks and benefits must be compared with all treatments used. While radiologic embolization is an alternative, it should be studied carefully and compared with other methods of
BEALL J, JAFEK BW. More on Epistaxis-Reply. Arch Otolaryngol. 1986;112(1):112. doi:10.1001/archotol.1986.03780010114024
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