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A rare case of non-traumatic intrasplenic pseudoaneurysms in a patient with acute T-cell lymphoblastic leukemia. J Ultrasound 2019; 24:85-90. [PMID: 31372947 DOI: 10.1007/s40477-019-00401-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/18/2019] [Indexed: 02/07/2023] Open
Abstract
Pseudoaneurysm (PSA) or false aneurysm is a vascular lesion resulting from a focal and incomplete rupture of the arterial wall (intimate and/or elastic lamina), that allows blood to escape into the arterial wall; this small contained break causes a contained collection of blood and the creation of a "new" less resistant vessel wall, consisting of adventitia and perivascular tissues. Intrasplenic pseudoaneurysms are rare and more frequently recognize traumatic origin, sometimes are also unexpected lesions due to non-recent trauma. In contrast, non-traumatic intrasplenic pseudoaneurysms are rare complications usually due to splenic infarction, infiltration by malignant systemic disorders, infectious process, chronic pancreatitis, and arteritis. Both traumatic and non-traumatic PSA are potentially life threatening, known to cause spontaneous rupture of the spleen with massive hemoperitoneum. Contrast-enhanced CT is the gold standard technique to detect splenic PSA; however, it is important to know how to recognize it also with other imaging methods such as with ultrasound (US) and contrast-enhanced ultrasound (CEUS). US and CEUS can be often the first-line diagnostic techniques and allow to detect these lesions; they are also very useful in the follow-up. Our case report can be a reminder of the utility of the US and CEUS in detecting splenic pseudoaneurysms, which are potentially a life-threatening complication; we also recall the semiotics of these lesions with baseline ultrasound (US), color Doppler US and contrast-enhanced ultrasound (CEUS). Then, we highlight the role of contrast-enhanced CT in confirming the diagnosis and we report about the diagnostic and therapeutic value of angiography. We have to think about the possibility of a pseudoaneurysm even in the absence of a recent trauma, associated with other conditions such as a lymphoproliferative disease.
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Partial Splenic Embolization Is a Safe and Effective Alternative in the Management of Portal Hypertension in Children. J Pediatr Gastroenterol Nutr 2019; 68:793-798. [PMID: 30908386 DOI: 10.1097/mpg.0000000000002332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE There are multiple approaches to manage the clinical complications of portal hypertension (PHTN) to treat/prevent spontaneous hemorrhage by mitigating thrombocytopenia. No single approach is ideal for all patients given the heterogeneity of this population. Our goal was to determine whether partial splenic embolization (PSE) was safe and effective in the pediatric population. METHODS This is a retrospective review of our single-center experience for all patients ages 0 to 21 who underwent PSE between January 2010 and August 2017. The embolized splenic volume targeted was 60% to 70%. RESULTS Twenty-six patients underwent PSE due to thrombocytopenia and/or recurrent variceal bleeding. Patients ranged in age from 18 months to 20 years (mean 13.1 years). The median platelet count before PSE was 53.0 (×10/L). The platelet count improved after PSE with values >100,000 in 21 patients (80.8%). Children with prior esophageal varices showed improvement after PSE with only 9 (34.6%) requiring further endoscopic therapy. After PSE, patients developed transient abdominal pain, distention, fever, and perisplenic fluid collections. Serious complications such as splenic abscess, splenic rupture, bleeding, pancreatic infarction, opportunistic infection, or death were not observed. One patient experienced thrombotic complications after PSE and was later diagnosed with myelodysplastic syndrome. CONCLUSIONS PSE is a safe and effective alternative in the management of pediatric PHTN in select populations. PSE may be a favorable alternative to splenectomy and portal systemic shunting because it preserves functional spleen mass and avoids postprocedure accelerated liver disease or encephalopathy.
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Quencer KB, Smith TA. Review of proximal splenic artery embolization in blunt abdominal trauma. CVIR Endovasc 2019; 2:11. [PMID: 32026033 PMCID: PMC7224246 DOI: 10.1186/s42155-019-0055-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/07/2019] [Indexed: 11/11/2022] Open
Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Unstable patients undergo laparotomy and splenectomy. Stable patients with lower grade injuries are treated conservatively; those stable patients with moderate to severe splenic injuries (grade III-V) benefit from endovascular splenic artery embolization. Two widely used embolization approaches are proximal and distal splenic artery embolization. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained via collateral pathways. Distal embolization can be used in cases of focal injury. In this article we review relevant literature on splenic embolization indication, and technique, comparing and contrasting proximal and distal embolization. Additionally, we review relevant anatomy and discuss collateral perfusion pathways following proximal embolization. Finally, we review potential complications of splenic artery embolization.
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Affiliation(s)
- Keith Bertram Quencer
- Division of Interventional Radiology, University of Utah Department of Radiology, 30 N. 1900 E., Salt Lake City, UT, 84132, USA
| | - Tyler Andrew Smith
- Division of Interventional Radiology, University of Utah Department of Radiology, 30 N. 1900 E., Salt Lake City, UT, 84132, USA.
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Development of the human pancreas and its vasculature — An integrated review covering anatomical, embryological, histological, and molecular aspects. Ann Anat 2019; 221:115-124. [DOI: 10.1016/j.aanat.2018.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 01/18/2023]
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Bundy JJ, Hage AN, Srinivasa RN, Gemmete JJ, Srinivasa RN, Jairath N, Anand R, Dasika N, Lee E, Chick JFB. Intra-arterial ampicillin and gentamicin and the incidence of splenic abscesses following splenic artery embolization: A 20-year case control study. Clin Imaging 2018; 54:6-11. [PMID: 30476679 DOI: 10.1016/j.clinimag.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/26/2018] [Accepted: 10/02/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Splenic abscesses represent a major complication following splenic artery embolization. The purpose of this study was to assess the effectiveness of intra-arterial antibiotics administered during splenic artery embolization in reducing splenic abscess formation. MATERIALS AND METHODS 406 patients were screened. 313 (77.1%) patients who underwent splenic artery embolization and were >18 years old were included. Mean age of the cohort was 58 ± 15 years (range: 18-88 years). There were 205 (65.5%) male patients and 108 (34.5%) female patients. 197 (62.9%) patients underwent embolization without intra-arterial antibiotics and 116 (37.1%) patients underwent embolization with 1 g ampicillin and 80 mg gentamicin administered in an intra-arterial fashion. Primary outcome was splenic abscess formation. Secondary outcomes included type of splenic artery embolization, embolic agent, and technical success. RESULTS Partial splenic embolization was performed in 229 (73.1%) patients. Total splenic embolization was performed in 84 (26.8%) patients. Platinum coils were the most commonly used embolic agent overall (n = 178; 56.9%) followed by particulates (n = 114; 36.4%). Embolization technical success was achieved in 312 (99.7%) patients. 7 (3.6%) splenic abscesses were detected in the non-intra-arterial antibiotic group and 1 (0.9%) in the intra-arterial antibiotic cohort (P = 0.27). Coils were found to be statistically more likely to result in splenic abscesses than any other embolic agent (P = 0.03). Mean time to abscess identification was 74 days ±120 days (range: 9-1353 days). CONCLUSION Splenic abscesses occurred more frequently in patients who did not receive intra-arterial antibiotics during splenic embolization; however, this did not reach statistical significance.
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Affiliation(s)
- Jacob J Bundy
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America
| | - Anthony N Hage
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America
| | - Ravi N Srinivasa
- Department of Radiology, Division of Interventional Radiology, University of California Los Angeles, 757 Western Plaza, Los Angeles, CA 90095, United States of America
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America
| | - Rajiv N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America
| | - Neil Jairath
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America
| | - Rohit Anand
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America
| | - Narasimham Dasika
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America
| | - Eunjee Lee
- Department of Information and Statistics, Chungnam National University 99 Daehak-ro, Yuseong-gu, Daejeon 34134, South Korea
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America; Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA 22304, United States of America.
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Choi W, Choi YB. Splenic embolization for a giant splenic hemangioma in a child: a case report. BMC Pediatr 2018; 18:354. [PMID: 30419881 PMCID: PMC6233546 DOI: 10.1186/s12887-018-1331-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Splenic hemangioma is the most common benign tumor of the spleen. However, it remains a rare medical condition in children. Although the natural course of splenic hemangioma is slow growth, treatment for large splenic hemangiomas has been recommended due to the risk of spontaneous rupture causing life-threating hemorrhage. However, the optimal treatment for splenic hemangioma in children is unclear. CASE PRESENTATION An 11-year-old girl had an enhancing mass, 61 × 54 × 65 mm in size and numerous daughter nodules throughout the entire spleen on a contrast-enhanced computed tomography scan of the abdomen and angiography. The patient was treated by complete embolization at the distal level of splenic artery, which resulted in total splenic infarction. Treatment-related complications were thrombocytosis and postembolization syndrome, including abdominal pain and, intermittent fever below 39 °C. There were no other serious complications, including bleeding. CONCLUSION Splenic embolization may be a safe and less invasive intervention for children with a large splenic hemangioma. Further studies are needed to confirm the effectiveness of our approach.
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Affiliation(s)
- Woosun Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Young Bae Choi
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea.
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Abstract
Objective This study was performed to investigate the efficacy of proximal splenic
artery embolization using detachable balloons for patients with
hypersplenism and portal hypertension. Methods Twelve patients diagnosed with hypersplenism with thrombocytopenia or
leukocytopenia caused by portal hypertension were treated by proximal
splenic artery embolization with detachable balloons and metallic fibered
coils. All patients were followed for up to 6 months. Blood parameters,
coagulation factors, and liver function indicators were measured. Enhanced
computed tomography and abdominal ultrasonography examinations were also
performed in advance to confirm the infarction area and evaluate the changes
in spleen size. Results Postoperative angiography demonstrated complete embolization of the proximal
splenic artery in all 12 patients. Thrombocyte and leukocyte counts rose
significantly in all patients in 2 weeks and stayed significantly higher
than those before embolization throughout the 6-month follow-up. The total
bilirubin concentration and prothrombin activity recovered significantly and
returned to normal levels 6 months later. Computed tomography revealed
partial infarction and liquefaction of the splenic parenchyma in nine
patients. Conclusions Proximal splenic artery embolization using detachable balloons could be
considered a safe and effective therapeutic modality in alleviating
hypersplenism secondary to portal hypertension.
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Affiliation(s)
- Xiaoxi Pang
- Peking University First Hospital, Peking University, Beijing, P.R. China
| | - Tengyu Li
- Peking University First Hospital, Peking University, Beijing, P.R. China
| | - Cheng'en Wang
- Peking University First Hospital, Peking University, Beijing, P.R. China
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Partial splenic embolization in the treatment of prolonged thrombocytopenia due to hypersplenism in metastatic cancer patients. Support Care Cancer 2018; 26:3527-3532. [DOI: 10.1007/s00520-018-4192-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/03/2018] [Indexed: 12/21/2022]
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Korda D, Deák PÁ, Kiss G, Gerlei Z, Kóbori L, Görög D, Fehérvári I, Piros L, Máthé Z, Doros A. Management of Portal Hypertension After Liver Transplantation. Transplant Proc 2018; 49:1530-1534. [PMID: 28838434 DOI: 10.1016/j.transproceed.2017.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Post-transplantation portal hypertension has severe complications, such as esophageal varix bleeding, therapy refractory ascites, extreme splenomegaly, and graft dysfunction. The aim of our study was to analyze the effectiveness of the therapeutic strategies and how to visualize the procedure. METHODS A retrospective study involving liver transplantation patients from the Semmelweis University Department of Transplantation and Surgery was performed between 2005 and 2015. The prevalence, etiology, and leading complications of the condition were determined. The applied interventions' effects on the patients' ascites volume, splenic volume, and the occurrence of variceal bleeding were determined. Mean portal blood flow velocity and congestion index values were calculated using Doppler ultrasonography. RESULTS The prevalence of post-transplantation portal hypertension requiring intervention was 2.8%. The most common etiology of the disease was portal anastomotic stenosis. The most common complications were esophageal varix bleeding and therapy refractory ascites. The patients' ascites volume decreased significantly (2923.3 ± 1893.2 mL vs. 423.3 ± 634.3 mL; P < .05), their splenic volume decreased markedly. After the interventions, only one case of recurrent variceal bleeding was reported. The calculated Doppler parameters were altered in the opposite direction in cases of pre-hepatic versus intra- or post-hepatic portal hypertension. After the interventions, these parameters shifted towards the physiologic ranges. CONCLUSION The interventions performed in our clinic were effective in most cases. The patients' ascites volume, splenic volume, and the prevalence of variceal bleeding decreased after the treatment. Doppler ultrasonography has proved to be a valuable imaging modality in the diagnosis and the follow-up of post-transplantation portal hypertension.
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Affiliation(s)
- D Korda
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
| | - P Á Deák
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - G Kiss
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Z Gerlei
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - L Kóbori
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - D Görög
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - I Fehérvári
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - L Piros
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Z Máthé
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - A Doros
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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Arisar FAQ, Shah SHA, Haq TU. Partial Splenic Artery Embolization in Cirrhosis Is a Safe and Useful Procedure. OPEN JOURNAL OF GASTROENTEROLOGY 2018; 08:327-336. [DOI: https:/doi.org/10.4236/ojgas.2018.89035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Misiakos EP, Bagias G, Liakakos T, Machairas A. Laparoscopic splenectomy: Current concepts. World J Gastrointest Endosc 2017; 9:428-437. [PMID: 28979707 PMCID: PMC5605342 DOI: 10.4253/wjge.v9.i9.428] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/21/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Since early 1990’s, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes.
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Affiliation(s)
- Evangelos P Misiakos
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
| | - George Bagias
- Clinic for General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasios Machairas
- 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece
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de la Pinta C, Fernández Lizarbe E, Montero Luis Á, Domínguez Rullán JA, Sancho García S. Treatment of symptomatic splenomegaly with low doses of radiotherapy: Retrospective analysis and review of the literature. Tech Innov Patient Support Radiat Oncol 2017; 3-4:23-29. [PMID: 32095563 PMCID: PMC7033798 DOI: 10.1016/j.tipsro.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/09/2017] [Accepted: 08/09/2017] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To evaluate the effectiveness of low doses of radiation therapy for symptomatic splenomegaly in malignant and benign diseases. PATIENTS AND METHODS 5 patients with symptomatic splenomegaly were treated with low doses of radiation in our centre (January 2008-December 2016). 4/5 patients had malignant neoplasia (acute myeloid leukemia, non Hogdkin lymphoma and prolymphocytic B cell leukemia) and splenomegaly was caused by extramedullary hematopoiesis. 1/5 patient had benign disease (HBV liver cirrhosis) and splenomegaly was caused by vascular ectasia. Median age was 73 years (range 61-86 years). There were 4 females and 1 male. These patients had exclusively splenic pain or abdominal discomfort in 20%, exclusively cytopenias 40% and both 40%. Patients needed radiation therapy for symptomatic control. Dose per fraction was 0.5 Gy every two days; total dose initially prescribed 10 Gy. IGRT were performed in all patients to ensure an appropriate position and to adapt the treatment volume to the changes in the spleen volume along the treatment. Median craneocaudal length size of the spleen was more than 26 cm (range 15.2-34.9 cm). RESULTS Median radiation doses were 4.85 Gy (range 2.5-10). Median craneocaudal spleen size reduction was 4.6 cm (0-8 cm). Splenic pain and abdominal disturbances improved in all patients. Median increase of haemoglobin and platelets levels was 1.6 mg/dl and 27.950 cells respectively in the first week after the end of radiotherapy.One patient had to interrupt her treatment due to grade II neutropenia. No other toxicities were described. With a median follow-up of 39 months (16-89 months), only one recurrence was described at 24 months and consisted of thrombocytopenia. The patient received a second course of radiotherapy with excellent response. CONCLUSION Low doses of radiation therapy for treatment of symptomatic splenomegaly were effective, with a low rate of side effects. Splenic pain and abdominal discomfort completely improved and cytopenias rised to secure levels.
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Canbak T, Acar A, Tolan HK, Başak F. Giant splenic artery aneurysm: A case report. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2017. [DOI: 10.25000/acem.300740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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El-Menyar A, Abdelrahman H, Al-Hassani A, Peralta R, AbdelAziz H, Latifi R, Al-Thani H. Single Versus Multiple Solid Organ Injuries Following Blunt Abdominal Trauma. World J Surg 2017; 41:2689-2696. [DOI: 10.1007/s00268-017-4087-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Golse N, Mohkam K, Rode A, Pradat P, Ducerf C, Mabrut JY. Splenectomy during whole liver transplantation: a morbid procedure which does not adversely impact long-term survival. HPB (Oxford) 2017; 19:498-507. [PMID: 28233673 DOI: 10.1016/j.hpb.2017.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/16/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Indications for splenectomy (SP) during whole liver transplantation (LT) remain controversial and SP is often avoided because of common complications. We aimed to evaluate specific complications of these combined procedures. METHODS Data were retrospectively analysed. Splenectomy was performed in patients with splenorenal shunt and/or splenic artery aneurysms or hypersplenism. Patients undergoing simultaneous transplantation and splenectomy (LTSP group) were matched to a non-splenectomy group (LT group). RESULTS Between 1994 and 2013, we included 47 and 94 patients in LTSP and LT groups, respectively. The LTSP patients had a higher rate of pre-LT portal vein thrombosis (PVT). The LTSP group had a longer operative time and greater blood loss. Mean follow-up was 101 months and 5-year survivals were identical (LTSP 85% vs LT 88%, p = 0.831). Hospital morbidity and rejection incidence were comparable, whereas de novo PVT (34% vs 2%, p < 0.0001) and infection (47% vs 25%, p = 0.014) rates were higher after SP. CONCLUSION Splenectomy during LT is technically demanding and exposes recipients to a higher thrombosis rate, therefore portal vein patency must be specifically assessed postoperatively. In selected recipients, SP can be performed without increased mortality but at the price of worsening outcome as evidenced by greater risk of infection and PVT.
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Affiliation(s)
- Nicolas Golse
- Croix-Rousse Hospital, Digestive Surgery and Liver Transplant Department, Hospices Civils de Lyon, Lyon, France.
| | - Kayvan Mohkam
- Croix-Rousse Hospital, Digestive Surgery and Liver Transplant Department, Hospices Civils de Lyon, Lyon, France.
| | - Agnès Rode
- Croix-Rousse Hospital, Radiology Department, Hospices Civils de Lyon, Lyon, France.
| | - Pierre Pradat
- Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1052, CRCL, Lyon, France; Centre for Clinical Research, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Christian Ducerf
- Croix-Rousse Hospital, Digestive Surgery and Liver Transplant Department, Hospices Civils de Lyon, Lyon, France.
| | - Jean-Yves Mabrut
- Croix-Rousse Hospital, Digestive Surgery and Liver Transplant Department, Hospices Civils de Lyon, Lyon, France.
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Koç O, Acar K, Özbek O, Güler İ, Sarıtaş K, Erdem TB, Solak Y, Toy H, Küçükapan A, Özbek S, Gaipov A, Haznedaroğlu İC. Splenic artery embolization with Ankaferd blood stopper in a sheep model. Diagn Interv Radiol 2017; 22:354-7. [PMID: 27306661 DOI: 10.5152/dir.2015.15382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Splenic artery embolization is a minimally invasive therapeutic procedure utilized in a number of disorders. Ankaferd blood stopper (ABS) is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We aimed to investigate the safety and efficiency of ABS for splenic artery embolization in a sheep model. METHODS Seven adult female sheep were included in the study. Selective celiac angiography was performed using a 5F diagnostic catheter and then a 2.7F hydrophilic coating microcatheter was advanced coaxially to the distal part of the main splenic artery. Under fluoroscopic guidance, 6 mL mixture composed of half-and-half ABS and contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration and stagnation of the flow. Control celiac angiograms were obtained immediately after the embolization. After the procedure, the animals were observed for one day and then sacrificed with intravenous sodium thiopental. RESULTS Technical success rate was 100%. None of the animals died or experienced a major systemic adverse event during the procedure. All of the spleens appeared dark on macroscopic examination due to excessive thrombosis. Microscopically, the majority of the splenic sinusoids (90%-95%) were necrotic. CONCLUSION In our study, splenic artery embolization by ABS was found to be safe and effective in the short-term. Further studies are needed to better understand the embolizing potential of this novel hemostatic agent.
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Affiliation(s)
- Osman Koç
- Department of Radiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey.
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Hughes J, Scrimshire A, Steinberg L, Yiannoullou P, Newton K, Hall C, Pearce L, Macdonald A. Interventional Radiology service provision and practice for the management of traumatic splenic injury across the Regional Trauma Networks of England. Injury 2017; 48:1031-1034. [PMID: 28292519 DOI: 10.1016/j.injury.2017.02.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/19/2017] [Accepted: 02/24/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of blunt splenic injuries (BSI) has evolved toward strategies that avoid splenectomy. There is growing adoption of interventional radiology (IR) techniques in non-operative management of BSI, with evidence suggesting a corresponding reduction in emergency laparotomy requirements and increased splenic preservation rates. Currently there are no UK national guidelines for the management of blunt splenic injury. This may lead to variations in management, despite the reorganisation of trauma services in England in 2012. MATERIALS AND METHODS A survey was distributed through the British Society of Interventional Radiologists to all UK members aiming to identify availability of IR services in England, radiologists' practice, and attitudes toward management of BSI. RESULTS 116 responses from respondents working in 23 of the 26 Regional Trauma Networks in England were received. 79% provide a single dedicated IR service but over 50% cover more than one hospital within the network. All offer arterial embolisation for BSI. Only 25% follow guidelines. In haemodynamically stable patients, an increasing trend for embolisation was seen as grade of splenic injury increased from 1 to 4 (12.5%-82.14%, p<0.01). In unstable patients or those with radiological evidence of bleeding, significantly more respondents offer embolisation for grade 1-3 injuries (p<0.01), compared to stable patients. Significantly fewer respondents offer embolisation for grade 5 versus 4 injuries in unstable patients or with evidence of bleeding. CONCLUSION Splenic embolisation is offered for a variety of injury grades, providing the patient remains stable. Variation in interventional radiology services remain despite the introduction of regional trauma networks.
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Affiliation(s)
- Jane Hughes
- Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1).
| | - Ashley Scrimshire
- Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1).
| | - Laura Steinberg
- Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1).
| | - Petros Yiannoullou
- Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1).
| | - Katherine Newton
- Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1).
| | - Claire Hall
- Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1).
| | - Lyndsay Pearce
- Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1).
| | - Andrew Macdonald
- Health Education England North West, University Hospitals of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK(1).
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Garrett HE, Mack L. Coil Embolization of Spontaneous Splenic Arteriovenous Fistula for Treatment of Portal Hypertension. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:386-390. [PMID: 28396581 PMCID: PMC5395133 DOI: 10.12659/ajcr.901845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Female, 64 Final Diagnosis: Splenic arteriovenous fistula Symptoms: Left lower quadrant abdominal pain Medication: — Clinical Procedure: Coiling embolization Specialty: Surgery
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Affiliation(s)
- H Edward Garrett
- Division of Vascular Surgery, University of Tennessee, Memphis, TN, USA
| | - Lamar Mack
- Division of Vascular Surgery, University of Tennessee, Memphis, TN, USA
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Assal F, El Kassas M, Esmail E, Elbadry AA, Abousaif S, Mahdy R, Elfert A. Microwave ablation in the spleen versus partial splenic artery embolisation: A new technique for hypersplenism in cirrhosis. Arab J Gastroenterol 2017; 18:25-29. [PMID: 28256406 DOI: 10.1016/j.ajg.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/24/2016] [Accepted: 01/01/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND STUDY AIMS Splenectomy has been associated with high perioperative morbidity and mortality. Partial splenic artery embolisation (PSE) was found to be an effective and safer method but with numerous complications. Local thermal ablative techniques such as microwave ablation (MWA) have been tried and were found to be safe and effective alternatives. This randomised controlled study aimed to compare the efficacy and safety of MWA versus PSE in the treatment of hypersplenism in patients with post-hepatitis C cirrhosis. PATIENTS AND METHODS In total, 40 patients with post-hepatitis C cirrhosis complicated with hypersplenism were randomised into two groups: Group I: 20 patients treated with percutaneous MWA of splenic parenchyma under ultrasound guidance and Group II: 20 patients treated with PSE using Embosphere. RESULTS There was a significant increase in haemoglobin levels in group I compared with group II after 3months of follow-up. However, White blood cell (WBC) count and platelets significantly increased more in group II than in group I after 1month. Postprocedure significant hyperbilirubinaemia, hypoalbuminaemia, decreased prothrombin concentration, and increased creatinine levels were encountered in group II only. There was a significant increase in postoperative complications in group II compared to group I, and a single case of mortality was reported in group II. CONCLUSION MWA and PSE were comparably effective; however, MWA was safer than PSE, which caused serious adverse events and mortality. MWA appears to be a good alternative for the treatment of hypersplenism in patients with cirrhosis and portal hypertension.
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Affiliation(s)
- Fathia Assal
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
| | - Eslam Esmail
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr A Elbadry
- Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sabry Abousaif
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Reem Mahdy
- Internal Medicine Department, Assiut University, Assiut, Egypt
| | - Asem Elfert
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Li C, Kapoor B, Moon E, Quintini C, Wang W. Current understanding and management of splenic steal syndrome after liver transplant: A systematic review. Transplant Rev (Orlando) 2017; 31:188-192. [PMID: 28254530 DOI: 10.1016/j.trre.2017.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/30/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Splenic steal syndrome (SSS) is a condition that can occur after orthotopic liver transplant (OLT). However, limited information is available about this condition. METHODS A systematic literature search of studies performed through May 2016 was conducted to identify reports of angiographically confirmed SSS and its variants. All of the factors relevant to this disorder were collected and analyzed. RESULTS A total of 219 cases of SSS and its variants were identified. The condition occurred in 4.7% of patients after OLT, and 93.7% of cases were diagnosed within the first 2 months after OLT. Conventional arteriography demonstrated nonocclusive hepatic artery hypoperfusion in all affected patients. Abnormal liver function was the most common clinical presentation, reported in 71.9% of cases. Less common presentations included thrombocytopenia, acute graft failure, and persistent ascites. On Doppler ultrasound, a high resistance index of the hepatic artery was present in 84.1% of patients. Increased spleen volume (≥829 mL) before OLT was suggestive of a potential risk for SSS. Splenic artery embolization (SAE) was performed in 94.7% of cases; this procedure immediately reversed flow abnormalities on Doppler ultrasound and improved liver function tests in 96.3% of cases. CONCLUSIONS The risk factors and potential etiologies of SSS remain largely unknown. Future studies should investigate the possible role of pre-OLT portal hypertension and portal hyperperfusion after OLT in the development of this syndrome. Collecting intraoperative hemodynamic data and performing Doppler ultrasound screening after OLT could potentially help clinicians to identify patients at high risk of arterial hypoperfusion and prevent potential complications from hepatic artery hypoperfusion.
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Affiliation(s)
- Chaolun Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China
| | - Baljendra Kapoor
- Imaging Institute, Cleveland Clinic, Section of Interventional Radiology, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Eunice Moon
- Imaging Institute, Cleveland Clinic, Section of Interventional Radiology, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Cristiano Quintini
- Department of General Surgery, Liver Transplant Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Weiping Wang
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA.
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71
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Li LY, Chen HZ, Bao YC, Yu QS, Yang WM. Successful Treatment of Hypersplenism in Wilson's Disease by Partial Splenic Embolization. J INVEST SURG 2017; 31:75-81. [PMID: 28135891 DOI: 10.1080/08941939.2016.1278058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Liang-Yong Li
- Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Huai-Zhen Chen
- Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Yuan-Cheng Bao
- Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Qing-Sheng Yu
- Department of General Surgery, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Wen-Ming Yang
- Department of Neurology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
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Tcbc-Rj RAF, Ferreira MCL, Ferreira DAL, Ferreira AGL, Ramos FO. Splenic artery aneurysm. Rev Col Bras Cir 2016; 43:398-400. [PMID: 27982336 DOI: 10.1590/0100-69912016005005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/01/2016] [Indexed: 11/21/2022] Open
Abstract
Splenic artery aneurysms - the most common visceral artery aneurysms - are found most often in multiparous women and in patients with portal hypertension. Indications for treatment of splenic artery aneurysm or pseudoaneurysm include specific symptoms, female gender and childbearing age, presence of portal hypertension, planned liver transplantation, a pseudoaneurysm of any size, and an aneurysm with a diameter of more than 2.5cm. Historically, the treatment of splenic artery aneurysm has been surgical ligation of the splenic artery, ligation of the aneurysm, or aneurysmectomy with or without splenectomy, depending on the aneurysm location. There are other percutaneous interventional techniques. The authors present a case of a splenic artery aneurysm in a 51-year-old woman, detected incidentally. RESUMO Aneurismas da artéria esplênica - os aneurismas arteriais viscerais mais comuns - são encontrados mais frequentemente em mulheres multíparas e em pacientes com hipertensão portal. As indicações para o seu tratamento incluem sintomas específicos, sexo feminino e idade fértil, presença de hipertensão portal, paciente em fila de transplante hepático, um pseudoaneurisma de qualquer tamanho, e um aneurisma com um diâmetro superior a 2,5cm. Historicamente, o tratamento do aneurisma da artéria esplênica tem sido a ligadura cirúrgica da artéria esplênica, a ligadura do aneurisma ou a aneurismectomia, com ou sem esplenectomia, dependendo do local do aneurisma. Existem outras técnicas intervencionistas percutâneas. Os autores apresentam o caso de um aneurisma de artéria esplênica em uma mulher de 51 anos de idade, diagnosticado incidentalmente.
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73
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Frandon J, Rodiere M, Arvieux C, Vendrell A, Boussat B, Sengel C, Broux C, Bricault I, Ferretti G, Thony F. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery? Diagn Interv Radiol 2016; 21:327-33. [PMID: 26081719 DOI: 10.5152/dir.2015.14800] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. METHODS Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. RESULTS The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural drainage, acute renal failures, and pancreatitis in OM and more pseudocysts in SAE. Six prognostic factors were statistically significant for one or more adverse events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. CONCLUSION Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury.
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Affiliation(s)
- Julien Frandon
- Clinique Universitaire de Radiologie et d'Imagerie Médicale, Grenoble University Hospital, Grenoble, France.
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Cormack RJ, Ferris MC, Wong JK, Przybojewski S. Splenic artery embolisation in the non-operative management of blunt splenic trauma in adults. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The purpose of this study was to evaluate the splenic salvage rate with angioembolisation in the non-operative management (NOM) of blunt splenic injury.Methods: We conducted a retrospective analysis of patients presenting to our Level I trauma centre with computed tomography (CT)-confirmed splenic injury following blunt trauma and in whom angioembolisation was utilised in the algorithm of NOM. Data review included CT and angiography findings, embolisation technique and patient outcomes.Results: Between January 2005 and April 2010, 60 patients with splenic injury following blunt trauma underwent NOM, which included splenic artery embolisation (SAE). All patients included in the study required a preadmission. CT scan was used to document the American Association for the Surgery of Trauma (AAST) grade of splenic injury. The average injury grade was 3.0. The non-operative splenic salvage rate following SAE was 96.7% with statistically similar salvage rates achieved for grades II to IV injuries. The quantity of haemoperitoneum and the presence of a splenic vascular injury did not significantly affect the splenic salvage rate. The overall complication rate was 27%, of which 15% were minor and 13% were major.Conclusion: SAE is a safe and effective treatment strategy in the NOM of blunt splenic injury. The quantity of haemoperitoneum, the presence of vascular injury and embolisation technique did not significantly affect the splenic salvage rate.
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75
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Sharma H, Al Hasan I, Al-Judabi B. Partial splenic embolization for gastroesophageal variceal bleeding: A potential long waiting to be tapped. Saudi J Gastroenterol 2016; 22:397-398. [PMID: 27976633 PMCID: PMC5184738 DOI: 10.4103/1319-3767.195557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Hemant Sharma
- Department of Liver Transplantation and Hepatology, Western University, London, Ontario, Canada
| | - Ibrahim Al Hasan
- Department of Liver Transplantation and Hepatology, Western University, London, Ontario, Canada
| | - Bandar Al-Judabi
- Department of Liver Transplantation and Hepatology, Western University, London, Ontario, Canada,Department of Medicine, Division of Gastroenterology, King Saud University, Riyadh Saudi Arabia,Department of Medicine, Division of Gastroenterology, University of Rochester, Rochester, New York, USA,Address for correspondence: Dr. Bandar Al-Judaibi, Division of Gastroenterology, University Hospital, London, Ontario, Canada. E-mail:
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Cai D, Parajuly SS, Wang H, Wang X, Ling W, Song B, Li Y, Luo Y. Accuracy of contrast-enhanced ultrasound compared with conventional ultrasound in acute pancreatitis: Diagnosis and complication monitoring. Exp Ther Med 2016; 12:3189-3194. [PMID: 27882136 PMCID: PMC5103763 DOI: 10.3892/etm.2016.3760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/01/2016] [Indexed: 02/05/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) has been used for diagnosing acute pancreatitis (AP), particularly severe acute pancreatitis (SAP). However, the diagnostic difference between CEUS and conventional ultrasonography (CUS) for AP and SAP has not been reported. The aim of the present study was to investigate the diagnostic accuracy of CUS and CEUS for AP. A total of 196 patients clinically diagnosed with AP were selected. All patients underwent CUS, CEUS and contrast-enhanced computed tomography (CECT) within 72 h. CECT was considered the gold standard. Pancreatic size, peripancreatic fluid collection (PPFC) and splenic vessel complications were the variables observed by CUS and CEUS. The differences in the variables among the three methods were analyzed using the χ2 test and statistical analysis software. Significant differences in pancreatic size, PPFC and splenic vessel complications in AP were observed between CEUS and CUS (P<0.05). χ2 test results indicated that CEUS significantly differed from CUS in terms of having a higher diagnostic accuracy for AP and SAP (P<0.05). The results indicate that CEUS is a reliable method for the diagnosis and monitoring of AP and SAP, and may be substituted for CECT.
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Affiliation(s)
- Diming Cai
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Shyam Sundar Parajuly
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Huiyao Wang
- Training Department of Resident Doctor, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiaoling Wang
- Department of Operations Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yongzhong Li
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
- Correspondence to: Dr Yan Luo, Department of Ultrasound, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan 610041, P.R. China, E-mail:
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77
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Luz JHM, Luz PM, Marchiori E, Rodrigues LA, Gouveia HR, Martin HS, Faria IM, Souza RR, Gil RDA, Palladino ADM, Pimenta KB, de Souza HS. Partial splenic embolization to permit continuation of systemic chemotherapy. Cancer Med 2016; 5:2715-2720. [PMID: 27611010 PMCID: PMC5083724 DOI: 10.1002/cam4.856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/08/2016] [Accepted: 07/16/2016] [Indexed: 12/16/2022] Open
Abstract
Systemic chemotherapy treatments, commonly those that comprise oxaliplatin, have been linked to the appearance of distinctive liver lesions that evolves to portal hypertension, spleen enlargement, platelets sequestration, and thrombocytopenia. This outcome can interrupt treatment or force dosage reduction, decreasing efficiency of cancer therapy. We conducted a prospective phase II study for the evaluation of partial splenic embolization in patients with thrombocytopenia that impeded systemic chemotherapy continuation. From August 2014 through July 2015, 33 patients underwent partial splenic embolization to increase platelets count and allow their return to treatment. Primary endpoint was the accomplishment of a thrombocyte level superior to 130 × 109/L and the secondary endpoints were the return to chemotherapy and toxicity. Partial splenic embolization was done 36 times in 33 patients. All patients presented gastrointestinal cancer and colorectal malignancy was the commonest primary site. An average of 6.4 cycles of chemotherapy was done before splenic embolization and the most common regimen was Folfox. Mean platelet count prior to embolization was 69 × 109/L. A total of 94% of patients achieved primary endpoint. All patients in need reinitiated treatment and median time to chemotherapy return was 14 days. No grade 3 or above adverse events were identified. Aiming for a 50% to 70% infarction area may be sufficient to achieve success without the complications associated with more extensive infarction. Combined with the better safety profile, partial splenic embolization is an excellent option in the management of thrombocytopenia, enabling the resumption of systemic chemotherapy with minimal procedure‐related morbidity.
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Affiliation(s)
- Jose Hugo M Luz
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
| | - Paula M Luz
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo A Rodrigues
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Hugo R Gouveia
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Henrique S Martin
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Igor M Faria
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Roberto R Souza
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Roberto de Almeida Gil
- Department of Clinical Oncology, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | | | - Karina B Pimenta
- Department of Anesthesiology, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Henrique S de Souza
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
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Talving P, Rauk M, Vipp L, Isand KG, Šamarin A, Põder K, Rätsep I, Saar S. Necrosis of the tail of pancreas following proximal splenic artery embolization. J Surg Case Rep 2016; 2016:rjw087. [PMID: 27177891 PMCID: PMC4866485 DOI: 10.1093/jscr/rjw087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The current case report presents a rare complication of a significant pancreatic tail necrosis following proximal splenic artery embolization in a 32-year-old male patient involved in a motorcycle accident. Proximal angiographic embolization of the splenic injury after trauma is a widely accepted method with excellent success rate; however, possible complications may occur and has been described in the literature. Nevertheless, only a few case reports pertinent to clinically significant pancreatic tail necrosis after the SAE has been reported. Thus, we add a case report to the scarce literature pertinent to this detrimental and rare complication.
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Affiliation(s)
- Peep Talving
- Department of Surgery, Division of Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
| | - Mariliis Rauk
- Department of Surgery, Division of Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
| | - Liisa Vipp
- Department of Surgery, Division of Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
| | - Karl-Gunnar Isand
- Department of Surgery, Division of Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
| | - Aleksandr Šamarin
- Department of Radiology, North Estonia Medical Center, Tallinn, Estonia
| | - Kalle Põder
- Department of Radiology, North Estonia Medical Center, Tallinn, Estonia
| | - Indrek Rätsep
- Department of Anesthesiology and Intensive Care, North Estonia Medical Center, Tallinn, Estonia
| | - Sten Saar
- Department of Surgery, Division of Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
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Wernick B, Cipriano A, Odom SR, MacBean U, Mubang RN, Wojda TR, Liu S, Serres S, Evans DC, Thomas PG, Cook CH, Stawicki SP. Temporal changes in hematologic markers after splenectomy, splenic embolization, and observation for trauma. Eur J Trauma Emerg Surg 2016; 43:399-409. [PMID: 27167236 DOI: 10.1007/s00068-016-0679-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/02/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The spleen is one of the most commonly injured abdominal solid organs during blunt trauma. Modern management of splenic trauma has evolved to include non-operative therapies, including observation and angioembolization to preclude splenectomy in most cases of blunt splenic injury. Despite the shift in management strategies, relatively little is known about the hematologic changes associated with these various modalities. The aim of this study was to determine if there are significant differences in hematologic characteristics over time based on the treatment modality employed following splenic trauma. We hypothesized that alterations seen in hematologic parameters would vary between observation (OBS), embolization (EMB), and splenectomy (SPL) in the setting of splenic injury. METHODS An institutional review board-approved, retrospective study of routine hematologic indices examined data between March 2000 and December 2014 at three academic trauma centers. A convenience sample of patients with splenic trauma and admission lengths of stay >96 h was selected for inclusion, resulting in a representative sample of each sub-group (OBS, EMB, and SPL). Basic demographics and injury severity data (ISS) were abstracted. Platelet count, red blood cell (RBC) count and RBC indices, and white blood cell (WBC) count with differential were analyzed between the time of admission and a maximum of 1080 h (45 days) post-injury. Comparisons between OBS, EMB, and SPL groups were then performed using non-parametric statistical testing, with statistical significance set at p < 0.05. RESULTS Data from 130 patients (40 SPL, 40 EMB, and 50 OBS) were analyzed. The median age was 40 years, with 67 % males. Median ISS was 21.5 (21 for SPL, 19 for EMB, and 22 for OBS, p = n/s) and median Glasgow Coma Scale (GCS) was 15. Median splenic injury grade varied by interventional modality (grade 4 for SPL, 3 for EMB, and 2 for OBS, p < 0.05). Inter-group comparisons demonstrated no significant differences in RBC counts. However, mean corpuscular volume (MCV) and RBC distribution width (RDW) were elevated in the SPL and EMB groups (p < 0.01). Similarly, EMB and SPL groups had higher platelet counts than the OBS group (p < 0.01). In aggregate, WBC counts were highest following SPL, followed by EMB and OBS (p < 0.01). Similar trends were noted in neutrophil and monocyte counts (p < 0.01), but not in lymphocyte counts (p = n/s). CONCLUSION This study describes important trends and patterns among fundamental hematologic parameters following traumatic splenic injuries managed with SPL, EMB, or OBS. As expected, observed WBC counts were highest following SPL, then EMB, and finally OBS. No differences were noted in RBC count between the three groups, but RDW was significantly greater following SPL compared to EMB and OBS. We also found that MCV was highest following OBS, when compared to EMB or SPL. Finally, our data indicate that platelet counts are similarly elevated for both SPL and EMB, when compared to the OBS group. These results provide an important foundation for further research in this still relatively unexplored area.
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Affiliation(s)
- B Wernick
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - A Cipriano
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - S R Odom
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - U MacBean
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - R N Mubang
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - T R Wojda
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - S Liu
- Temple University School of Medicine-St. Luke's University Hospital Campus, Bethlehem, PA, USA
| | - S Serres
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - D C Evans
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - P G Thomas
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - C H Cook
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA. .,Department of Research & Innovation, St. Luke's University Health Network, EW2 Research Administration, 801 Ostrum Street, Bethlehem, PA, 18020, USA.
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Helaly AZ, Al-Warraky MS, El-Azab GI, Kohla MAS, Abdelaal EE. Portal and splanchnic hemodynamics after partial splenic embolization in cirrhotic patients with hypersplenism. APMIS 2016; 123:1032-9. [PMID: 26547369 DOI: 10.1111/apm.12470] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 09/28/2015] [Indexed: 01/28/2023]
Abstract
To assess the acute effects of partial splenic embolization (PSE) on portal and splanchnic hemodynamics in patients with cirrhosis. Ninety-five patients with hypersplenism were included in the study. Duplex examinations were performed before and 3 and 7 days after PSE. Portal and splanchnic hemodynamics including vessel cross-sectional area (CSA), mean flow velocities (cm/s), blood flows (mL/min), Doppler indices as portal congestion index (CI), liver vascular index, hepatic artery and superior mesenteric artery (SMA) pulsatility and resistive indices (PI and RI), were performed before and after PSE. In our study, 69 of 95 patients were males (72.6%) and 26 females (27.3%). Chronic hepatitis C virus infection was the main cause of cirrhosis (81.1%). PSE failed technically in six patients (6.3%). After PSE, both CSA and CI significantly decreased (p < 0.05 and <0.01). The portal vein velocity significantly increased (p < 0.01). The portal flow volume (892.4 ± 151 mL/min) did not show significant changes. The hepatic artery RI and PI showed a steady increase that became significant 7 days post-PSE (p < 0.05). The RI and PI of SMA increased significantly after 7 days of PSE (p < 0.05). PSE has an immediate portal decompression effect in patients with portal hypertension without reduction in portal flow. This effect on portal pressure should be investigated in future studies as a potential tool for management of acute variceal bleeding when other medical procedures fail.
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Affiliation(s)
- Ahmed Z Helaly
- Internal Medicine Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Mohamed S Al-Warraky
- Department of Radiology, National Liver Institute, Menoufiya University, Shebeen El kom, Egypt
| | - Gasser I El-Azab
- Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El kom, Egypt
| | - Mohamed A S Kohla
- Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El kom, Egypt
| | - Elsayed E Abdelaal
- Department of Hepatology, National Liver Institute, Menoufiya University, Shebeen El kom, Egypt
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Zhu J, Chen X, Hu X, Zhu H, He C. A Comparative Study of Surgical Splenectomy, Partial Splenic Embolization, and High-Intensity Focused Ultrasound for Hypersplenism. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:467-474. [PMID: 26839374 DOI: 10.7863/ultra.15.03050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This study compared splenectomy, partial splenic embolization, and high-intensity focused ultrasound (HIFU) therapy, which represent the traditional, mature, and newest methods for improving thrombocytopenia in hypersplenism, respectively. METHODS A total of 69 patients with hypersplenism were treated with surgical splenectomy (n = 31), HIFU (n = 26), or partial splenic embolization (n = 12). They were followed closely for at least 6 months, and the effectiveness of the treatments was compared. RESULTS Among the 3 groups, splenectomy was the most effective treatment for increasing peripheral blood cells. Embolization reduced the operating time and hospital stay, but HIFU was relatively safer and less invasive than the other treatments. CONCLUSIONS High-intensity focused ultrasound has wide clinical indications for hypersplenism and may be safer than other treatment methods. Therefore, it is a good alternative procedure for patients with a high surgical risk.
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Affiliation(s)
- Jing Zhu
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.)
| | - Xijun Chen
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.)
| | - Xiaotong Hu
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.)
| | - Hui Zhu
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.)
| | - Chao He
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.).
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Price M, Patino M, Sahani D. Computed Tomography Angiography of the Hepatic, Pancreatic, and Splenic Circulation. Radiol Clin North Am 2015; 54:55-70. [PMID: 26654391 DOI: 10.1016/j.rcl.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Multidetector computed tomography angiography (MDCTA) has become a routine imaging tool to assess visceral vascular anatomy and abdominal parenchymal pathology. Enhanced temporal resolution and rapid acquisition allow for precise delineation of arterial and venous anatomy. The excellent spatial resolution permits assessment of small parenchyma lesions and vasculature. The ability of CT to rapidly acquire data and reconstruct with thinner slices allows robust 3D mapping using maximum intensity projection before definitive surgical or interventional therapy. Emerging novel techniques of image acquisition offer sensitive methods for detecting enhancement and allow for virtual imaging subtraction, all while limiting the total radiation burden.
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Affiliation(s)
- Melissa Price
- Division of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Manuel Patino
- Division of Abdominal Imaging, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Dushyant Sahani
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA.
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D'Amico M, Miraglia R, Caruso S, Maruzzelli L, Cortis K, Luca A. Endovascular Embolization of a Large High-Flow Splenic Arteriovenous Fistula and Aneurysm Using the Amplatzer Vascular Plug II. Ann Vasc Surg 2015; 31:210.e1-3. [PMID: 26627321 DOI: 10.1016/j.avsg.2015.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/07/2015] [Accepted: 09/08/2015] [Indexed: 11/19/2022]
Abstract
We describe the use of an Amplatzer Vascular Plug (AVP) II for embolizing a large high-flow splenic arteriovenous fistula and an aneurysm in a young patient. This patient presented to our center with persistent mild abdominal discomfort, 5 years after open splenectomy. Contrast-enhanced computed tomography angiography showed the presence of a fistula between the splenic arterial and splenic venous remnants and a resultant fusiform aneurysmal dilatation of the residual splenic vein. We decide to embolize the splenic artery with a 12-mm diameter AVP II with an oversizing by 70% of the vessel diameter. Celiac angiography performed 5 min postembolization revealed complete obliteration of the splenic artery and closure of the arteriovenous fistula. The overall procedure time was 40 min, and overall radiation exposure was 32 Gy cm(2) (dose-area product).
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Affiliation(s)
- Mario D'Amico
- Department of Diagnostic and Therapeutic Services, Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy; Department of Radiology, Di.Bi.Me.F., University of Palermo, Palermo, Italy
| | - Roberto Miraglia
- Department of Diagnostic and Therapeutic Services, Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.
| | - Settimo Caruso
- Department of Diagnostic and Therapeutic Services, Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Luigi Maruzzelli
- Department of Diagnostic and Therapeutic Services, Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Kelvin Cortis
- Department of Diagnostic and Therapeutic Services, Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Angelo Luca
- Department of Diagnostic and Therapeutic Services, Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
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Teixeira G, Martins J, Machado R, Loureiro L, Loureiro T, Borges L, Silveira D, Teixeira S, Rego D, Ferreira V, Gonçalves J, Antunes I, Matos A, Almeida R. Enfarte e abcesso esplénico maciço após tratamento endovascular de aneurisma da artéria esplénica. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hemamalini. Unusual Course of Splenic Artery: A Case Report. J Clin Diagn Res 2015; 9:AD05-6. [PMID: 26557507 DOI: 10.7860/jcdr/2015/14539.6622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022]
Abstract
Splenic artery is the largest branch from the celiac trunk. It is remarkably tortuous in its course before it enters the hilum of the spleen. During routine dissection of abdomen for undergraduate students in a 60-year-old male cadaver, we observed an unusual course and tortuosity in the splenic artery. Knowledge of such unusual tortuous splenic artery is important in partial or total splenectomy, splenic aneurysum, splenic embolisation and surgeries related to pancreas, stomach.
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Affiliation(s)
- Hemamalini
- Assistant Professor, Department of Anatomy, JSS Medical College , Mysore, India
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86
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Cirugía preservadora de órgano tras traumatismo esplénico cerrado con implicación hiliar. CIR CIR 2015; 83:516-21. [DOI: 10.1016/j.circir.2015.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 10/03/2014] [Indexed: 11/17/2022]
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Novel use of the Surefire antireflux device in subtotal splenic embolization. J Vasc Surg Cases 2015; 1:242-245. [PMID: 31724570 PMCID: PMC6849926 DOI: 10.1016/j.jvsc.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/13/2015] [Indexed: 11/22/2022] Open
Abstract
An unstable patient presented with an enlarging splenic hematoma, for whom splenectomy was contraindicated. The decision was made to treat this patient with subtotal splenic embolization. Initial attempts at embolotherapy using a conventional end-hole catheter resulted in a false angiographic end point with reflux into short gastric arteries, likely due to splenic parenchymal pressurization from the hematoma. The Surefire antireflux device (Surefire Medical Inc, Westminster, Colo) was therefore employed. The Surefire device allowed successful subtotal splenic embolization. Whereas it is currently primarily used in hepatic interventional oncology, we have shown that it can be successfully used in other settings to increase embolization efficiency while mitigating nontargeted embolization.
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88
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Left-Sided Portal Hypertension: A Sinister Entity. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:234-239. [PMID: 28868415 PMCID: PMC5579986 DOI: 10.1016/j.jpge.2015.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 09/11/2015] [Indexed: 12/14/2022]
Abstract
Introduction Sinistral, or left-sided, portal hypertension (SPH) is a rare entity, with multiple potential causes. Gastrointestinal variceal bleeding and hypersplenism are its’ major clinical manifestations. The main aim of the present study is to summarize the clinical features of patients with SPH. Patients and methods This was a retrospective analysis of consecutive patients with present or previous diagnosis of SHP, observed in a Gastroenterology Department, in a period of 2 years. Patients with clinical, radiological or laboratory alterations suggestive of cirrhosis were excluded. Causes of SPH, clinical manifestations and outcomes were registered. Potential factors associated with gastrointestinal bleeding were analyzed. Results In the study period a total of 22 patients (male – 17; mean age – 59.6 ± 10.6 years) with SHP were included. Clinical manifestations were: asymptomatic/unspecific abdominal pain (n = 14); gastrointestinal bleeding (n = 8). Eleven (50%) patients had increased aminotransferases, GGT and/or alkaline phosphatase although liver function was normal in all of them. Causes of SPH were chronic pancreatitis (n = 7), acute pancreatitis (n = 7), pancreatic cancer (n = 4), pancreatic surgery (n = 3) and arteriovenous malformation (n = 1). All patients had gastric and/or esophageal varices and seven had splenomegaly. Five (22.7%) had thrombocytopenia, associated with hypersplenism. Five patients (22.7%) were submitted to endoscopic treatment and eight were submitted to splenic artery embolization and/or splenectomy. There were no cases of variceal rebleeding and two patients died. Patients without liver enzymes elevation had a higher probability of gastrointestinal bleeding (87.5% vs. 28.6%; p = 0.024). Conclusions Acute and chronic pancreatitis are the major causes of SHP. Gastrointestinal bleeding is the most important clinical manifestation and patients without liver enzyme elevation seem more prone to bleed. Specific treatment is seldom performed or needed.
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Konishi T, Nishihara H, Ito T, Tanaka Y. Infective endocarditis presenting initially with ileus complicated by dehiscence of annuloplasty ring. BMC Cardiovasc Disord 2015; 15:124. [PMID: 26466683 PMCID: PMC4607247 DOI: 10.1186/s12872-015-0113-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) on an annuloplasty ring dehiscence is uncommon after mitral valve repair. CASE PRESENTATION A 53-year-old man underwent mitral annuloplasty with a 24-mm ring for posterior mitral valve prolapse. He underwent repeat valve repair for recurrent mitral valve regurgitation 4 years later. He was re-hospitalised complaining of vomiting, nausea, general fatigue and left abdominal pain 2 months later, and presented with low-grade fever, leukocytosis and an elevated blood concentration of C-reactive protein. An abdominal computed tomography scan showed multiple embolisms in the liver, kidney and spleen. Transoesophageal echocardiography revealed mitral annuloplasty ring dehiscence and vegetations consistent with IE. The infected annuloplasty ring and vegetations were surgically excised. Blood cultures grew coagulasenegative staphylococcus aureus, consistent with the excised mitral valve histology. The postoperative course was uneventful, without recurrence of IE. CONCLUSIONS Embolic ileus as initial manifestation of IE is rare and might confuse the diagnosis and delay its management. Gastrointestinal signs and symptoms may be the initial manifestations of systemic embolization from infective endocarditis. Transoesophageal echocardiography effectively identified the presence of vegetations and mitral annuloplasty ring dehiscence.
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Affiliation(s)
- Takao Konishi
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan. .,Department of Translational Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
| | - Hiroshi Nishihara
- Department of Translational Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Tadashi Ito
- Department of Cardiovascular Surgery, Self Defence Forces Central Hospital, Tokyo, Japan
| | - Yoshiaki Tanaka
- Department of Cardiovascular Surgery, Saitama Eastern Cardiovascular Hospital, Saitama, Japan
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Berelavichus SV, Smirnov AV, Ionkin DA, Kriger AG, Dugarova RS. [Robot-assisted and laparoscopic partial splenectomy for nonparasitic cysts]. Khirurgiia (Mosk) 2015:41-48. [PMID: 26271563 DOI: 10.17116/hirurgia2015741-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
21 patients with nonparasitic spleen cysts were operated. Robot-assisted (RA) interventions were applied in 10 cases, laparoscopic--in 11 patients. Men surgery duration was 124 minutes in case of RA-technique and 120 minutes if laparoscopy was used. Blood loss was significantly lower in the group of RA resection (p=0.035). There were no conversions of access in the group of RA-operations while in group of laparoscopy conversion has been required in 1 case. We did not observe complications in case of RA-surgeries. Laparoscopic method was associated with 2 complications (left-sided hydrothorax and fluid accumulation in resection area). Postoperative hospital-stay did not differ in both groups and was 7.1 and 6.4 room-nights in case of RA-interventions and laparoscopy respectively. There were no deaths. Indications for robot-assisted partial splenectomy for nonparasitic cysts include location of mass in upper pole or hilus of spleen, its diameter more than 8 cm, body mass index more than 30 and splenomegaly. Lower pole resection and splenectomy are more advisable using laparoscopic method.
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Affiliation(s)
- S V Berelavichus
- A.V. Vishnevskiy Institute of Surgery Russian Ministry of Health, Moscow, Russia
| | - A V Smirnov
- A.V. Vishnevskiy Institute of Surgery Russian Ministry of Health, Moscow, Russia
| | - D A Ionkin
- A.V. Vishnevskiy Institute of Surgery Russian Ministry of Health, Moscow, Russia
| | - A G Kriger
- A.V. Vishnevskiy Institute of Surgery Russian Ministry of Health, Moscow, Russia
| | - R S Dugarova
- A.V. Vishnevskiy Institute of Surgery Russian Ministry of Health, Moscow, Russia
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91
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Feasibility of endovascular repair of splenic artery aneurysms using stent grafts. J Vasc Surg 2015; 62:1504-10. [PMID: 26365664 DOI: 10.1016/j.jvs.2015.07.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/14/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Percutaneous transcatheter embolization of splenic artery aneurysms (SAAs) has been widely accepted as the first line of treatment in patients with symptoms, rupture, or large aneurysm size. Although embolization can usually be performed safely, ischemic complications, such as splenic infarct or abscess, occur in some patients. This study evaluated the feasibility and outcomes of endovascular SAA repair (ESAAR) using stent grafts, which may allow treatment while preserving flow to the spleen. METHODS We reviewed the clinical data of all consecutive patients who underwent ESAAR using stent grafts. Brachial access was used except for patients with favorable angle of origin from the aorta. To overcome tortuosity and provide support, a coaxial system with a hydrophilic sheath was used. Low-profile 0.018-inch stent grafts were used for distal SAAs with a 10-mm to 15-mm length of proximal and distal segment of splenic artery measuring 4 to 11 mm in diameter. Follow-up included clinical examination and computed tomography imaging within 4 to 6 months after the procedure and yearly thereafter. End points were morbidity, stent graft patency, and freedom from endoleaks and reinterventions. RESULTS ESAAR was attempted in 10 patients, four males and six females, with median age of 64 years (range, 48-77 years). Median SAA size was 2.8 cm (range, 2-5.7 cm). Nine patients were asymptomatic, and one had pancreatitis and gastrointestinal bleeding. The arterial access site was the brachial artery in six patients and the femoral artery in four. Two patients had brachial and femoral access to facilitate splenic artery stenting. Technical success of ESAAR using stent grafts was 80% (8 of 10). In two patients with distal SAAs, stent graft placement was not possible due to excessive vessel tortuosity, and treatment was by coil embolization. One patient developed brachial artery thrombosis, which was treated surgically. There were no ischemic complications in patients treated by ESAAR with stent grafts. Median length of stay was 1 day. One patient treated by coil embolization developed splenic infarct, which required readmission for pain control. Median follow-up was 9 months. Follow-up imaging in all successfully stented patients revealed patent stent grafts, no endoleak, and no aneurysm sac enlargement. No reinterventions were required. CONCLUSIONS ESAAR using self-expandable stent grafts offers a viable alternative to coil embolization in selected patients with SAAs. Distal SAAs with excessive vessel tortuosity may result in technical failure requiring embolization. Among patients who underwent successful ESAAR, there were no ischemic complications, stent graft occlusions, endoleaks, or sac enlargement.
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Wang Q, Xiong B, Zheng C, Liang M, Han P. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients. Cardiovasc Intervent Radiol 2015; 39:353-8. [PMID: 26304614 PMCID: PMC4742494 DOI: 10.1007/s00270-015-1199-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022]
Abstract
Objective This retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding. Methods From August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed. Results In 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up. Conclusions Splenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.
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Affiliation(s)
- Qi Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
| | - ChuanSheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
| | - Ming Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, People's Republic of China.
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93
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Bhatia SS, Venkat S, Echenique A, Rocha-Lima C, Doshi MH, Salsamendi J, Barbery K, Narayanan G. Proximal Splenic Artery Embolization in Chemotherapy-Induced Thrombocytopenia: A Retrospective Analysis of 13 Patients. J Vasc Interv Radiol 2015; 26:1205-11. [DOI: 10.1016/j.jvir.2015.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 01/14/2023] Open
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94
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging of congenital pancreatic lesions: emphasis on key imaging features. Jpn J Radiol 2015. [DOI: 10.1007/s11604-015-0458-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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95
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Chiaradia M, Novelli L, Deux JF, Tacher V, Mayer J, You K, Djabbari M, Luciani A, Rahmouni A, Kobeiter H. Ruptured visceral artery aneurysms. Diagn Interv Imaging 2015; 96:797-806. [DOI: 10.1016/j.diii.2015.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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96
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Costi R, Castro Ruiz C, Zarzavadjian le Bian A, Scerrati D, Santi C, Violi V. Spleen hydatidosis treated by hemi-splenectomy: A low-morbidity, cost-effective management by a recently improved surgical technique. Int J Surg 2015; 20:41-5. [PMID: 26074292 DOI: 10.1016/j.ijsu.2015.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 05/11/2015] [Accepted: 06/01/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Splenic hydatidosis is a rare condition and is usually managed by total splenectomy, which is associated to various complications, including overwhelming post-splenectomy sepsis and thrombosis. Probably due to supposed technical difficulties, the partial splenectomy is rarely performed being often unknown to physicians, infectious disease specialists and surgeons. METHODS Demographic, clinical and surgical data were collected of four consecutive patients undergoing partial (or hemi-) splenectomy using an original, recently improved technique as a treatment for polar splenic hydatid cyst. The procedure implies a selective vascular ligation, a mechanical stapler-assisted section and haemostatic agents (Surgicel(®)) application on the cutting surface. Three patients were treated by laparotomy (including one affected by both liver and spleen localizations) whereas the last one was approached laparoscopically. RESULTS Partial splenectomy operative time reached 74 min (range: 60-94 min) and blood loss was 8 ml (range: 5-10 ml). Hospital stay was 5.6 days (range: 5-7 days). At a mean follow-up of 20 months (range: 12-36 months), outcomes were uneventful. CONCLUSIONS Partial splenectomy for hydatidosis is effective and safe. Physicians and surgeons should be aware of such an easy-to-catch option when dealing with benign splenic conditions, such as parasitic cysts. Cost-effectiveness, low morbidity and the possible prevention of splenectomy-related infectious complications should plead in favor of this technique in developing countries, where hydatidosis is endemic and post-splenectomy drugs and vaccines may be lacking.
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Affiliation(s)
- Renato Costi
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, Italy
| | - Carolina Castro Ruiz
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, Italy
| | - Alban Zarzavadjian le Bian
- Service de Chirurgie Digestive, Centre Hospitalier Simone Veil, Eaubonne, France; Laboratoire d'éthique médicale et de médecine légale, Université Paris Descartes, Paris, France.
| | - Daniele Scerrati
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, Italy
| | - Caterina Santi
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, Italy
| | - Vincenzo Violi
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, Italy; Unità operativa di Chirurgia Generale, Ospedale di Fidenza, Fidenza, Italy
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97
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Li YN, Miao XY, Qi HZ, Hu W, Si ZZ, Li JQ, Li T, He ZJ. Splenic artery trunk embolization reduces the surgical risk of liver transplantation. Hepatobiliary Pancreat Dis Int 2015; 14:263-8. [PMID: 26063026 DOI: 10.1016/s1499-3872(15)60337-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Portal hypertension is one of the most important clinical conditions that cause intraoperative intensive hemorrhage in cirrhotic patients undergoing liver transplantation. Pre-transplant portal decompression may reduce the intraoperative bleeding during liver transplantation. METHODS Splenic artery trunk embolization (SATE) was performed one month prior to liver transplantation. Platelet count, prealbumin, international normalized ratio, and blood flow in the portal vein and hepatic artery were monitored before and one month after SATE. The measurements above were collected on admission and before surgery in the non-SATE patients, who served as controls. We also recorded the intraoperative blood loss, operating time, required transfusion, post-transplant ascites, and complications within three months after operation in all patients. RESULTS SATE significantly reduced portal venous blood flow, increased hepatic arterial blood flow, normalized platelet count, and improved prealbumin and international normalized ratio in the patients before liver transplantation. Compared to the non-SATE patients, the pre-transplant SATE significantly decreased the operating time, intraoperative bleeding, post-transplant ascites and severe surgical complications. CONCLUSION Pre-transplant SATE decreases portal pressure, improves liver function reserve, and reduces the surgical risk of liver transplantation effectively in patients with severe portal hypertension.
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Affiliation(s)
- Yi-Ning Li
- Organ Transplantation Center, Department of Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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98
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Presser N, Quintini C, Tom C, Wang W, Liu Q, Diago-Uso T, Fujiki M, Winans C, Kelly D, Aucejo F, Hashimoto K, Eghtesad B, Miller C. Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients: a 5-year experience. Liver Transpl 2015; 21:435-41. [PMID: 25604488 DOI: 10.1002/lt.24081] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 10/26/2014] [Accepted: 12/04/2014] [Indexed: 02/07/2023]
Abstract
Severe portal hyperperfusion (PHP) after liver transplantation has been shown to cause intrahepatic arterial vasoconstriction secondary to increased adenosine washout (hepatic artery buffer response). Clinically, posttransplant PHP can cause severe cases of refractory ascites and hydrothorax. In the past, we reported our preliminary experience with the use of splenic artery embolization (SAE) as a way to reduce PHP. Here we present our 5-year experience with SAE in orthotopic liver transplantation (OLT). Between January 2007 and December 2011, 681 patients underwent OLT at our institution, and 54 of these patients underwent SAE for increased hepatic arterial resistance and PHP (n=42) or refractory ascites/hepatic hydrothorax (n=12). Patients undergoing SAE were compared to a control group matched by year of embolization, calculated Model for End-Stage Liver Disease score, and liver weight. SAE resulted in improvements in hepatic artery resistive indices (0.92±0.14 and 0.76±0.10 before and after SAE, respectively; P<0.001) and improved hepatic arterial blood flow (HAF; 15.6±9.69 and 28.7±14.83, respectively; P<0.001). Calculated splenic volumes and spleen/liver volume ratios were correlated with patients requiring SAE versus matched controls (P=0.002 and P=0.001, respectively). Among the 54 patients undergoing SAE, there was 1 case of postsplenectomy syndrome. No abscesses, significant infections, or bleeding was noted. We thus conclude that SAE is a safe and effective technique able to improve HAF parameters in patients with elevated portal venous flow and its sequelae.
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Affiliation(s)
- Naftali Presser
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH
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99
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Tun TN, Punamiya S. Gastric variceal bleeding precipitated by a mycotic splenic arteriovenous fistula in a cirrhotic patient: radiological diagnosis and endovascular treatment. Singapore Med J 2015; 55:e180-3. [PMID: 25631980 DOI: 10.11622/smedj.2014166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Splenic arteriovenous fistula (SAVF) is an unusual cause of portal hypertension, and is rarely associated with an infective aetiology. It is often difficult to identify SAVF clinically, and thus, radiological modalities are invariably required for diagnosis and treatment. We herein describe a case of SAVF occurring in a patient with compensated cirrhosis as a sequel to salmonella gastroenteritis, and presenting with acute gastric variceal bleeding. Selective transcatheter embolisation of the splenic artery was effective in controlling bleeding.
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Affiliation(s)
- Than Naing Tun
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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100
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Darki A, Goswami NJ, Mishkel GJ. Endovascular management of splenic artery aneurysms: case series using telescoping guide and cage/coil technique. Catheter Cardiovasc Interv 2014; 84:E65-70. [PMID: 24155131 DOI: 10.1002/ccd.25268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/07/2022]
Abstract
Splenic artery aneurysms are rare, but still the third most common abdominal aneurysm. Rupture is associated with significant morbidity and mortality. Traditionally, cardiologists have rarely been involved in the management of this entity. We present a series of four patients managed percutaneously by interventional cardiology using a combined telescoping guide and cage/coil technique.
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Affiliation(s)
- Amir Darki
- Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
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