How Is Temporal Artery Ligation Done?

Q: Dr. Eppley, I want to get the ligation of the temporal arteries done. I’ve heard from you from a forum on the internet with lots of success stories. But I still have a couple of questions. If you tie off the artery at several locations, isn’t it possible that there appear ‘new’ artery or that the capillary system ‘feeds’ the tied off artery, so blood returns to the artery? Is there any chance of hair loss? My temporal arteries bulge beyond my hairline, how can you determine to ligate it in the hair bearing region? How big are the scars? On my right there’s just ‘one’ artery, while the one on the left splits into three arteries, of whom 2 splits into 2 other very little arteries, so I’d need a lot of ligations on this side.

A: When it comes to temporal artery ligation, the key is to perform proximal ligation to cut off the very high anterograde flow and distal ligations of any identifiable branches to eliminate any retrograde flow. If all lines that feed into the visible ‘pipes’ are tied off, there is no way any blood flow can return to the artery. There is no capillary system that feeds into the arteries. This always requires an incision (10mms) in the temporal hairline and small incisions (5 – 7mms) beyond it in the forehead area wherever the distal and feeder branches cab be identified. There is no risk of hair loss with this procedure. The blood flow to the scalp is extensive and has many other feeder vessels for scalp and hair survival. If ever in doubt, you only do one side at a time.

Dr. Barry Eppley

Indianapolis, Indiana