Can My Failed Temporal Artery Ligation Be Made To Work?

Q: Dr. Eppley, I have a bulging temporal artery and my vascular surgeon has performed a ligation on it. (two incisions) However the artery began to bulge a few days after the operation. Do you have any advice for a second ligation that would be more effective? I have provided a picture as well. Please, any info is greatly appreciated. This thing is killing my self-esteem. 

Thank you for your time.

A: What you learn in temporal artery ligations is that two ligation points is insufficient.  While that seems like it would be effective (cut off the front and back flow) it never is. You have to go out further along its course and get several other ligation points as there are more vessels that feed into it that it appears with its superficial location. It would also be interesting to know the exact two locations where it has been ligated which is not obvious in your picture.

Dr. Barry Eppley

Indianapolis, Indiana