A case of severe arterial epistaxis treated by transantral ligation of the maxillary artery is reported. A 66-year-old woman had recurrent left sided epistaxis from the posterior nasal cavity which was difficult to control by conventional nasal packing methods. Selective angiography was performed to identify the arterial flow patterns and site of bleeding which was confirmed to be the descending palatine artery. Following radiographical examination, ligation and clipping of the maxillary artery and its branches was performed with transantral approach under general anesthesia. No further epistaxis occurred after the ligation. This surgical procedure seems to be relatively simple and highly effective in the management of refractory epistaxis.