Epistaxis is the most common otolaryngologic emergency requiring hospital admission. Patients with this disorder are usually managed conservatively beginning with the simplest mode of treatment with surgical arterial ligation being reserved for cases of failed nasal packing. The purpose of this retrospective review was to evaluate the efficacy of arterial ligation and document all of the complications secondary to these procedures, especially the minor complications secondary to transantral internal maxillary artery (IMAX) ligation. A total of 402 patients admitted to the Vancouver General Hospital between 1980-1990 with a primary diagnosis of epistaxis were the basis for this review. The hospital charts of those patients who underwent arterial ligation were reviewed. A phone questionnaire was directed to this group. External carotid artery (ECA) ligation was associated with a high rate of rebleeding (9/20-45%) during the 10 year follow-up period. IMAX ligation was an effective procedure for controlling epistaxis with a small number of rebleeds (3/29-10%). Although few major complications were noted in the IMAX ligation group, frequent minor complications were noted on prolonged follow-up. Despite this, patient satisfaction was very good in the IMAX ligation group.