Endoscopic Sphenopalatine Artery Ligation — Active Bleeding


  • Control of epistaxis
  • Vascular control prior to tumor removal


  • Incision is made over the palatine bone just posterior to maxillary fontanelle.
  • Crista ethmoidalis serves as a landmark just anterior to sphenopalatine foramen.
  • Endoscopic clip appliers facilitate clip application.

Keep in Mind/Things to Remember:

  • SPA may branch prior to exiting foramen, often with larger SPA branch and smaller posterior nasal branch.
  • Isolation of artery from surrounding fascia facilitates clip application and/or cauterization.