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Choy CH, Lee YS, Cheung PL, Ho CH, Siu JCW. Splenic Arterial Embolization for Trauma and Beyond: A Case Series. Vasc Specialist Int 2024; 40:18. [PMID: 38845443 PMCID: PMC11157332 DOI: 10.5758/vsi.240030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/11/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
Splenic artery embolization plays an important role in the management of various medical and surgical conditions that are non-traumatic in etiology, in addition to its well-established and widely discussed role in managing splenic trauma. In nontraumatic emergencies of catastrophic bleeding originating from the spleen or splenic artery, splenic artery embolization can be effective in achieving hemostasis as a definitive management, temporary stabilizing measure, or preoperative optimization technique. In addition to emergency clinical conditions, splenic artery embolization can be performed electively as an alternative to splenectomy for managing patients with hypersplenism. Herein, we report 6 cases of splenic artery embolization performed at our center to highlight its various indications. This article aims to demonstrate the role of splenic artery embolization in different clinical scenarios and the considerations behind the techniques employed through illustrative cases.
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Affiliation(s)
- Chun Hin Choy
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Yat Sing Lee
- Department of Radiology, Pok Oi Hospital, Hong Kong, China
| | - Pui Lam Cheung
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Cheuk Him Ho
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Jimmy Chi Wai Siu
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, Hong Kong, China
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O'Rourke C, McKee H, Wijeyaratnam DO, Bajwa J, Tremblay L, David E. Retrospective Evaluation of Splenic Artery Embolization Outcomes in the Management of Blunt Splenic Trauma: A Single Centre Experience at a Large Level 1 Trauma Centre. Can Assoc Radiol J 2023; 74:745-754. [PMID: 37026571 DOI: 10.1177/08465371231166946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
PURPOSE Retrospective review of splenic artery embolization (SAE) outcomes performed for blunt abdominal trauma. MATERIALS AND METHODS 11-year retrospective review at a large level-1 Canadian trauma centre. All patients who underwent SAE after blunt trauma were included. Technical success was defined as angiographic occlusion of the target vessel and clinical success was defined as successful non-operative management and splenic salvage on follow-up. RESULTS 138 patients were included of which 68.1% were male. The median age was 47 years (interquartile range (IQR) = 32.5 years). The most common mechanisms of injury were motor vehicle accidents (37.0%), mechanical falls (25.4%), and pedestrians hit by motor vehicles (10.9%). 70.3% of patients had American Association for the Surgery of Trauma (AAST) grade 4 injuries. Patients were treated with proximal SAE (n = 97), distal SAE (n = 23) or combined SAE (n = 18), and 68% were embolized with an Amplatzer plug. No significant differences were observed across all measures of hospitalization (Length of hospital stay: x2(2) = .358, P = .836; intensive care unit (ICU) stay: x2(2) = .390, P = .823; ICU stay post-procedure: x2(2) = 1.048, P = .592). Technical success and splenic salvage were achieved in 100% and 97.8% of patients, respectively. 7 patients (5%) had post-embolization complications and 7 patients (5%) died during hospital admission, but death was secondary to other injuries sustained in the trauma rather than complications related to splenic injury or its management. CONCLUSION We report that SAE as an adjunct to non-operative management of blunt splenic trauma can be performed safely and effectively with a high rate of clinical success.
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Affiliation(s)
- Colin O'Rourke
- Department of Vascular Interventional Radiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Hayley McKee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Jaspreet Bajwa
- Department of Vascular Interventional Radiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lorraine Tremblay
- Department of General Surgery and Trauma Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Elizabeth David
- Department of Vascular Interventional Radiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Comparison of outcomes of proximal versus distal and combined splenic artery embolization in the management of blunt splenic injury: a report of 202 cases from a single trauma center. Surg Endosc 2023:10.1007/s00464-023-09960-5. [PMID: 36890415 DOI: 10.1007/s00464-023-09960-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND To compare the outcomes of blunt splenic injuries (BSI) managed with proximal (P) versus distal (D) versus combined (C) splenic artery embolization (SAE). METHODS This retrospective study included patients with BSI who demonstrated vascular injuries on angiograms and were managed with SAE between 2001 and 2015. The success rate and major complications (Clavien-Dindo classification ≥ III) were compared between the P, D, and C embolizations. RESULTS In total, 202 patients were enrolled (P, n = 64, 31.7%; D, n = 84, 41.6%; C, n = 54, 26.7%). The median injury severity score was 25. The median times from injury to SAE were 8.3, 7.0, and 6.6 h for the P, D, and C embolization, respectively. The overall haemostasis success rates were 92.6%, 93.8%, 88.1%, and 98.1% in the P, D, and C embolizations, respectively, with no significant difference (p = 0.079). Additionally, the outcomes were not significantly different between the different types of vascular injuries on angiograms or the materials used in the location of embolization. Splenic abscess occurred in six patients (P, n = 0; D, n = 5; C, n = 1), although it occurred more commonly in those who underwent D embolization with no significant difference (p = 0.092). CONCLUSIONS The success rate and major complications of SAE were not significantly different regardless of the location of embolization. The different types of vascular injuries on angiograms and agents used in different embolization locations also did not affect the outcomes.
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Lin BC, Wu CH, Wong YC, Chen HW, Fu CJ, Huang CC, Wu CT, Hsieh CH. Splenic artery embolization changes the management of blunt splenic injury: an observational analysis of 680 patients graded by the revised 2018 AAST-OIS. Surg Endosc 2023; 37:371-381. [PMID: 35962229 PMCID: PMC9839812 DOI: 10.1007/s00464-022-09531-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/31/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND This study aimed to evaluate the management of blunt splenic injury (BSI) and highlight the role of splenic artery embolization (SAE). METHODS We conducted a retrospective review of all patients with BSI over 15 years. Splenic injuries were graded by the 2018 revision of the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS). Our hospital provide 24/7 in-house surgeries and 24/7 in-house interventional radiology facility. Patients with BSI who arrived hypotensive and were refractory to resuscitation required surgery and patients with vascular injury on abdominal computed tomography were considered for SAE. RESULTS In total, 680 patients with BSI, the number of patients who underwent nonoperative management with observation (NOM-obs), SAE, and surgery was 294, 234, and 152, respectively. The number of SAEs increased from 4 (8.3%) in 2001 to 23 (60.5%) in 2015 (p < 0.0001); conversely, the number of surgeries decreased from 21 (43.8%) in 2001 to 4 (10.5%) in 2015 (p = 0.001). The spleen-related mortality rate of NOM-obs, SAEs, and surgery was 0%, 0.4%, and 7.2%, respectively. In the SAE subgroup, according to the 2018 AAST-OIS, 234 patients were classified as grade II, n = 3; III, n = 21; IV, n = 111; and V, n = 99, respectively.; and compared with 1994 AST-OIS, 150 patients received a higher grade and the total number of grade IV and V injuries ranged from 96 (41.0%) to 210 (89.7%) (p < 0.0001). On angiography, 202 patients who demonstrated vascular injury and 187 achieved hemostasis after SAE with a 92.6% success rate. Six of the 15 patients failed to SAE preserved the spleen after second embolization with a 95.5% salvage rate. CONCLUSIONS Our data confirm the superiority of the 2018 AAST-OIS and support the role of SAE in changing the trend of management of BSI.
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Affiliation(s)
- Being-Chuan Lin
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan City, 333, Taiwan.
| | - Cheng-Hsien Wu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan
| | - Yon-Cheong Wong
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan
| | - Chen-Ju Fu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan
| | - Chen-Chih Huang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, Chang Gung Medical Foundation, New Taipei City, Taiwan
| | - Chen-Te Wu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan
| | - Chi-Hsun Hsieh
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan City, 333 Taiwan
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Zhou J, Feng Z, Liu S, Li X, Liu Y, Gao F, Shen J, Zhang YW, Zhao GS, Zhang M. Simultaneous CSM‐TACE with CalliSpheres® and partial splenic embolization using 8spheres® for hepatocellular carcinoma with hypersplenism: Early prospective multicenter clinical outcome. Front Oncol 2022; 12:998500. [DOI: 10.3389/fonc.2022.998500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
BackgroundPrimary hepatocellular carcinoma is often complicated with hepatitis and liver cirrhosis. Some patients develop different degrees of splenomegaly, hypersplenism and hypohepatia due to the aggravation of liver cirrhosis, which to some extent interfere with the treatment of tumors and even affect the prognosis of patients. In this study, we prospectively evaluate the efficacy and safety of simultaneous CalliSpheres® microspheres transcatheter arterial chemoembolization (CSM-TACE) and partial splenic embolization (PSE) using 8spheres® for hepatocellular carcinoma (HCC) with hypersplenism.MethodsNinety consecutive HCC patients with hypersplenism who underwent CSM-TACE were selected: 32 patients in CSM-TACE+PSE group, and 58 patients in CSM-TACE group. The peripheral blood cell counts (leukocyte, platelet (PLT), liver function and red blood cell (RBC)), CSM-TACE and/or PSE related complications, and the tumor control rate at 1 month after CSM-TACE were compared. The survival time and prognostic factors were also observed.ResultsBefore CSM-TACE, there were no significant differences in sex, age, Child-Pugh grade, tumor size, and alpha-fetoprotein (AFP) between the two groups. After CSM-TACE, the PLT and white blood cell (WBC) counts in CSM-TACE+PSE group were significantly higher than those in the CSM-TACE group (P<0.05). There were no significant differences in RBC before and after treatment (P > 0.05). In the CSM-TACE group, there were no significant differences in WBC, PLT, and RBC before and after treatment (P > 0.05). There was no significant difference in liver function at 1 month after treatment between the two groups. The cholinesterase (CHE) level in the CSM-TACE+PSE group after CSM-TACE+PSE was obviously higher than that before CSM-TACE+PSE and higher than that in the CSM-TACE group (P<0.05). However, the level of CHE returned to the preoperative level 1 month after CSM-TACE in the CSM-TACE group. The objective response rate (ORR) and median overall survival (OS) in the CSM-TACE+PSE group were higher than those in the CSM-TACE group (P<0.05). The adverse reactions of the two groups were fever, abdominal pain, stomach discomfort, nausea, and vomiting, and no serious complications occurred. The degree of abdominal pain and fever in the experimental group was lower than that in the control group (P > 0.05).ConclusionsSimultaneous CSM-TACE and PSE using domestic embolization particles for HCC with hypersplenism have good safety and efficacy and has a low incidence of PSE-related adverse events, it is conducive to improving liver function reserve, and can further improve the median OS.
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Boscà-Ramon A, Ratnam L, Cavenagh T, Chun JY, Morgan R, Gonsalves M, Das R, Ameli-Renani S, Pavlidis V, Hawthorn B, Ntagiantas N, Mailli L. Impact of site of occlusion in proximal splenic artery embolisation for blunt splenic trauma. CVIR Endovasc 2022; 5:43. [PMID: 35986797 PMCID: PMC9391208 DOI: 10.1186/s42155-022-00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Proximal splenic artery embolisation (PSAE) can be performed in stable patients with Association for the Surgery of Trauma (AAST) grade III-V splenic injury. PSAE reduces splenic perfusion but maintains viability of the spleen and pancreas via the collateral circulation. The hypothesized ideal location is between the dorsal pancreatic artery (DPA) and great pancreatic artery (GPA). This study compares the outcomes resulting from PSAE embolisation in different locations along the splenic artery. Materials and methods Retrospective review was performed of PSAE for blunt splenic trauma (2015–2020). Embolisation locations were divided into: Type I, proximal to DPA; Type II, DPA-GPA; Type III, distal to GPA. Fifty-eight patients underwent 59 PSAE: Type I (7); Type II (27); Type III (25). Data was collected on technical and clinical success, post-embolisation pancreatitis and splenic perfusion. Statistical significance was assessed using a chi-squared test. Results Technical success was achieved in 100% of cases. Clinical success was 100% for Type I/II embolisation and 88% for Type III: one patient underwent reintervention and two had splenectomies for ongoing instability. Clinical success was significantly higher in Type II embolisation compared to Type III (p = 0.02). No episodes of pancreatitis occurred post-embolisation. Where post-procedural imaging was obtained, splenic perfusion remained 100% in Type I and II embolisation and 94% in Type III. Splenic perfusion was significantly higher in the theorized ideal Type II group compared to Type I and III combined (p = 0.01). Conclusion The results support the proposed optimal embolisation location as being between the DPA and GPA.
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Brahmbhatt AN, Ghobryal B, Wang P, Chughtai S, Baah NO. Evaluation of Splenic Artery Embolization Technique for Blunt Trauma. J Emerg Trauma Shock 2021; 14:148-152. [PMID: 34759633 PMCID: PMC8527058 DOI: 10.4103/jets.jets_64_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/21/2020] [Accepted: 02/21/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Evaluate outcomes and radiation exposure across different splenic artery embolization (SAE) techniques for splenic injuries secondary to blunt trauma. Methods: This retrospective cohort study included patients 18 years of age or older who underwent SAE for splenic injury after blunt trauma from January 2011 to June 2019. Results: Sixty patients underwent angiography for splenic injury after blunt traumatic injury. Forty-four patients were embolized. Seventeen patients underwent proximal SAE, and 23 underwent distal SAE. Four patients had a combination of proximal and distal SAE. Eleven patients had subsequent major complications requiring splenectomy. There was no significant difference in major complication rate when comparing proximal SAE 29.4% versus distal SAE 21.7%. No significant difference was noted across the two groups with respect to age or grade of injury. There was a statistically significant difference (P = 0.004) in fluoroscopy time between the proximal 10.1 ± 4.2 min and distal group 17.8 ± 8.7 min. No statically significant difference was found in major complications when comparing coil versus gel foam embolization. Conclusion: Proximal SAE is associated with a significantly lower fluoroscopy time (P = 0.004). Complication rates are similar after proximal and distal SAE. No significant difference was found in major complication rates comparing coil versus gel foam embolization. Minor complications more commonly occurred after proximal embolization with gel-foam.
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Affiliation(s)
- Akshaar N Brahmbhatt
- Department of Imaging Sciences, Strong Memorial Hopsital, University of Rochester, Rochester, NY, USA
| | - Bishoy Ghobryal
- Department of Imaging Sciences, Strong Memorial Hopsital, University of Rochester, Rochester, NY, USA
| | - Patrick Wang
- Department of Imaging Sciences, Strong Memorial Hopsital, University of Rochester, Rochester, NY, USA
| | - Shahzaib Chughtai
- Department of Imaging Sciences, Strong Memorial Hopsital, University of Rochester, Rochester, NY, USA
| | - Nana Ohene Baah
- Department of Imaging Sciences, Strong Memorial Hopsital, University of Rochester, Rochester, NY, USA
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Kauvar DS, Polykratis IA, De Guzman R, Prince MD, Voelker A, Kheirabadi BS, Dubick MA. Evaluation of a novel hydrogel intravascular embolization agent in a swine model of fatal uncontrolled solid organ hemorrhage and coagulopathy. JVS Vasc Sci 2021; 2:43-51. [PMID: 34617057 PMCID: PMC8489201 DOI: 10.1016/j.jvssci.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/25/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Current agents for the intravascular embolization of traumatic hemorrhage are used off-label and have been minimally studied with respect to their performance under differing coagulation conditions. We studied the hemorrhage control efficacy of a novel, liquid, polyethylene glycol-based hydrogel delivered as two liquid precursors that polymerize within the target vessel in a unique animal model of severe solid organ injury with and without dilutional coagulopathy. Methods Anesthetized swine (n = 36, 45 ± 3 kg) had laparotomy and splenic externalization. Half underwent 50% isovolemic hemodilution with 6% hetastarch and cooling to 33°C-35°C (coagulopathic group). All animals had controlled 20 mL/kg hemorrhage and endovascular proximal splenic artery access with a 4F catheter via a right femoral sheath. Splenic transection and 5-minute free bleeding were followed by treatment (n = 5/group) with 5 mL of gelfoam slurry, three 6-mm coils, up to 6 mL of hydrogel, or no treatment (n = 3, control). Animals received 15 mL/kg plasma and were monitored for 6 hours with continuous blood loss measurement. Results Coagulopathy was successfully established, with coagulopathic animals having greater pretreatment blood loss and earlier mean time to death regardless of the treatment group. All control animals died within 100 minutes. Overall survival without coagulopathy was 5/5 for hydrogel, 4/5 for coil, and 3/5 for gelfoam. With coagulopathy, one hydrogel animal survived to the end of the experiment, with 2/4 hydrogel deaths occurring in the final hour of observation. In noncoagulopathic animals, hydrogel demonstrated improved survival time (P < .01) and post-treatment blood loss (1.46 ± 0.8 mL/kg) over controls (18.8 ± 0.7, P = .001), gelfoam (4.7 ± 1.3, P > .05), and coils (4.6 ± 1.5, P > .05). In coagulopathic animals, hydrogel had improved survival time (P = .003) and decreased blood loss (4.2 ± 0.8 mL/kg) compared with control (20.4 ± 4.2, P = .003). Conclusions The hydrogel demonstrated equivalent hemorrhage control performance to standard treatments under noncoagulopathic conditions and improved performance in the face of dilutional coagulopathy. This agent should be explored as a potential preferable treatment for the embolization of traumatic solid organ and other injuries. (JVS–Vascular Science 2021;2:43-51.) Clinical Relevance In a translational model of severe solid organ injury hemorrhage with and without coagulopathy, a novel hydrogel transarterial embolization agent demonstrated equivalent hemorrhage control performance to standard agents under noncoagulopathic conditions and improved performance in the face of dilutional coagulopathy. This agent represents a promising future treatment for the embolization of traumatic solid organ and other injuries.
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Affiliation(s)
- David S Kauvar
- Vascular Surgery Service, Brooke Army Medical Center, JBSA Fort Sam Houston, Tex.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md
| | - I Amy Polykratis
- Combat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Tex
| | - Rodolfo De Guzman
- Combat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Tex
| | - M Dale Prince
- Combat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Tex
| | - Amber Voelker
- Combat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Tex
| | - Bijan S Kheirabadi
- Combat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Tex
| | - Michael A Dubick
- Combat Casualty Care, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Tex
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Cretcher M, Panick CEP, Boscanin A, Farsad K. Splenic trauma: endovascular treatment approach. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1194. [PMID: 34430635 PMCID: PMC8350634 DOI: 10.21037/atm-20-4381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
The spleen is a commonly injured organ in blunt abdominal trauma. Splenic preservation, however, is important for immune function and prevention of overwhelming infection from encapsulated organisms. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become an important component of non-operative management (NOM). SAE decreases the blood pressure to the spleen to allow healing, but preserves splenic perfusion via robust collateral pathways. SAE can be performed proximally in the main splenic artery, more distally in specific injured branches, or a combination of both proximal and distal embolization. No definitive evidence from available data supports benefits of one strategy over the other. Particles, coils and vascular plugs are the major embolic agents used. Incorporation of SAE in the management of blunt splenic trauma has significantly improved success rates of NOM and spleen salvage. Failure rates generally increase with higher injury severity grades; however, current management results in overall spleen salvage rates of over 85%. Complication rates are low, and primarily consist of rebleeding, parenchymal infarction or abscess. Splenic immune function is felt to be preserved after embolization with no guidelines for prophylactic vaccination against encapsulated bacteria; however, a complete understanding of post-embolization immune changes remains an area in need of further investigation. This review describes the history of SAE from its inception to its current role and indications in the management of splenic trauma. The endovascular approach, technical details, and outcomes are described with relevant examples. SAE is has become an important part of a multidisciplinary strategy for management of complex trauma patients.
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Affiliation(s)
- Maxwell Cretcher
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Catherine E P Panick
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Alexander Boscanin
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
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Comparison of three embolic materials at partial splenic artery embolization for hypersplenism: clinical, laboratory, and radiological outcomes. Insights Imaging 2021; 12:85. [PMID: 34173891 PMCID: PMC8236018 DOI: 10.1186/s13244-021-01030-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/08/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose To compare effectiveness of three widely used embolic agents in partial splenic embolization (PSE) by analyzing their clinical, laboratory, and radiological outcomes within one year of follow-up. Materials and methods This retrospective study examined 179 patients who underwent PSE to manage hypersplenism secondary to cirrhosis. Patients were divided into 3 groups according to embolic agent used. Group 1 (gelatin sponge) included 65 patients, group 2 (embospheres) included 58 patients, and group 3 (PVA) included 56 patients. Clinical, laboratory, and radiological outcomes were compared between groups. Results The technical success rate was 100% in all groups. Pain as a major complication was lower in the gelatin sponge group (20%) compared to the embosphere group (31%) and PVA group (32.3%). Major complications other than pain were found in 20.1%; 24.6% in gelatin sponge group, 15.5% in embosphere group and 19.6% in PVA group (p = 0.045). WBCs and platelet counts showed a significant increase after PSE in all groups. Entire splenic volume as measured by computed tomography after PSE showed no significant difference among the 3 groups; however, the volume of infarcted spleen was significantly lower in the gelatin sponge group compared to other two groups (p = 0.001). The splenic span was significantly reduced one-year post-procedure in three groups (p = 0.006), and it was significantly less in embosphere and PVA groups compared to gelatin sponge group (p < 0.05). Recurrent bleeding was higher in gelatin sponge group (p < 0.05). Conclusions Permanent embolic materials achieved better laboratory and radiological outcomes than gelatin sponge particles in PSE of cirrhotic hypersplenism patients. However, permanent particles were associated with greater abdominal pain.
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A pilot randomized controlled trial of endovascular coils and vascular plugs for proximal splenic artery embolization in high-grade splenic trauma. Abdom Radiol (NY) 2021; 46:2823-2832. [PMID: 33386906 DOI: 10.1007/s00261-020-02904-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 09/28/2020] [Accepted: 12/06/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the feasibility of enrolling patients in a randomized controlled trial (RCT) comparing endovascular coils (EC) and vascular plugs (VP) for proximal splenic artery embolization (pSAE) in high-grade splenic trauma, and to collect data to inform the design of a larger clinical effectiveness trial. METHODS Single-center, prospective, RCT of patients with Grade III-V splenic injuries selected for nonoperative management. Patients were randomized to pSAE with EC or VP. The main outcome was feasibility. We also evaluated technical success, time to stasis, complications, mortality, and splenectomy rates, by estimating rates and 95% confidence intervals. RESULTS 46 of 50 eligible patients were enrolled (92%, 95% CI 90-100%). Overall, splenic salvage was 98% (45/46; 95% CI 94-100%). Primary technical success was observed in 22 EC patients (96%; 95% CI 87-100%) and 20 VP patients (87%; 95% CI 73-100%). Bayesian analysis suggests a > 80% probability that primary technical success is higher for EC. Two complications (one major and one minor) occurred in the EC group (9%; CI 0-20%) and one major complication occurred in the VP group (4%; CI 0-13%). CONCLUSIONS Randomized comparisons of endovascular devices used for pSAE after trauma are feasible. pSAE using either EC or VP results in excellent rates of splenic salvage in trauma patients with high-grade splenic injuries. These high rates of splenic salvage and low rates of complications make their use as a primary outcome in a future trial problematic. Consideration should be given to technical parameters as a primary outcome for future trials.
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Özlüer YE, Avcil M, Dizman SE. Successful angioembolization with autologous subcutaneous fat in an open book pelvic fracture. Turk J Emerg Med 2021; 21:79-81. [PMID: 33969244 PMCID: PMC8091995 DOI: 10.4103/2452-2473.309133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/05/2020] [Accepted: 09/20/2020] [Indexed: 11/04/2022] Open
Abstract
Arterial bleeding due to pelvic fracture can be life-threatening, and angiographic embolization is the gold standard for its control. Various materials have been described, but most of them are not widely available, mainly because of the high costs. Here, we report a case of use of autologous subcutaneous fat tissue for successfully controlling bleeding in a patient with an anterior-posterior pelvic fracture.
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Affiliation(s)
- Yunus Emre Özlüer
- Department of Emergency Medicine, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Mücahit Avcil
- Department of Emergency Medicine, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Sadık Erdem Dizman
- Department of Emergency Medicine, Adnan Menderes University School of Medicine, Aydın, Turkey
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13
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Habash M, Ceballos D, Gunn AJ. Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes. Semin Intervent Radiol 2021; 38:105-112. [PMID: 33883807 DOI: 10.1055/s-0041-1724010] [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: 10/21/2022]
Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.
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Affiliation(s)
- Majd Habash
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Darrel Ceballos
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew J Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Raats JW, van Dam L, van Doormaal PJ, van Hengel-Jacobs M, Langeveld-Benders H. Neonatal Rupture of the Spleen: Successful Treatment with Splenic Artery Embolization. AJP Rep 2021; 11:e58-e60. [PMID: 34055461 PMCID: PMC8159580 DOI: 10.1055/s-0041-1727257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/28/2021] [Indexed: 11/03/2022] Open
Abstract
Neonatal intra-abdominal hemorrhage has been rarely reported in the literature. We report a case of splenic injury in a neonate, highlighting the importance of a high-index suspicion in early recognition of this rare and potentially fatal injury. We report the first case of a neonate who had a splenic rupture and underwent successful endovascular treatment.
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Affiliation(s)
- Jelle W Raats
- Department of Pediatric Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Lievay van Dam
- Department of Interventional Radiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pieter J van Doormaal
- Department of Interventional Radiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marjoleine van Hengel-Jacobs
- Department of Pediatrics, Division of Neonatology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Hester Langeveld-Benders
- Department of Pediatric Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
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15
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Clements W, Mathew J, Fitzgerald MC, Koukounaras J. Splenic Artery Embolization after Delayed Splenic Rupture Following Blunt Trauma: Is Nonoperative Management Still an Option in This Cohort? J Vasc Interv Radiol 2021; 32:586-592. [PMID: 33551305 DOI: 10.1016/j.jvir.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 10/22/2022] Open
Abstract
Patients treated with splenic artery embolization (SAE) >48 hours after a blunt injury for a delayed splenic rupture (DSR) were assessed for the need for a subsequent splenectomy. Thirty-four patients underwent SAE for DSR over 10 years at our level 1 trauma center, performed at a median of 4.5 days after the injury (interquartile range = 5.5), and the patients were followed up for a median of 11 months (interquartile range = 31). There were 3 occurrences of rebleeds, and 2 patients required splenectomy (5.9%). This study showed that treatment with SAE after DSR results in splenic salvage in 94.1% of patients.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Australia; National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.
| | - Joseph Mathew
- Department of Trauma, Alfred Health, Melbourne, Victoria, Australia; National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia
| | - Mark C Fitzgerald
- Department of Trauma, Alfred Health, Melbourne, Victoria, Australia; National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Australia
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16
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Clements W, Joseph T, Koukounaras J, Goh GS, Moriarty HK, Mathew J, Phan TD. SPLEnic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study. CVIR Endovasc 2020; 3:92. [PMID: 33283253 PMCID: PMC7719586 DOI: 10.1186/s42155-020-00185-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As an adjunct to non-operative management, splenic artery embolization (SAE) has been increasingly utilized throughout the world and is now the standard of care for hemodynamically stable patients. This study aimed to retrospectively assess the rate of splenic salvage and complications after SAE for blunt trauma at a level 1 trauma center using the 2018 update to the AAST criteria, and further sub-stratify the role of angiography in AAST grade III injuries with significant hemoperitoneum. All patients between 1 January 2009 and 1 January 2019 who underwent blunt trauma and proceeded to embolization were included. Data was collected concerning initial injury grade, location of embolization, type of embolic material used, complications, and need for subsequent splenectomy. Technical success was defined as successful angiographic occlusion of the target artery at the conclusion of embolization. Clinical success was defined as splenic salvage at discharge. Vascular lesions were characterized including those with active bleeding, pseudoaneurysm, and arterio-venous fistula. RESULTS Two hundred thirty-two patients were included in the study. Treatments were performed at a median of 0 days (range 0-28 days) and the median AAST grade was IV (range III-V). Technical success was achieved in all patients. There were 13 complications (5.6%) consisting of re-bleed (9, 3.9%), infarction (3, 1.3%), and access site haematoma (1, 0.43%). Clinical success was achieved in 97% of patients with 7 patients requiring splenectomy after SAE (3.0%) at a median time of 4 days (range 0-17 days). Angiography in patients with grade III injuries identified 18 occult vascular injuries not identified at initial CT (p < 0.0001). CONCLUSIONS The SPLEEN-IN study shows that treatment of intermediate-high grade blunt force traumatic splenic injuries using SAE resulted in a low rate of complication and splenic salvage in 97% of patients, providing a safe and effective treatment in stable patients. In addition, angiography of grade III injuries identified occult vascular lesions and may warrant treatment of select patients in this cohort. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Surgery, Monash University, Melbourne, Australia. .,National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.
| | - Tim Joseph
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Gerard S Goh
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Surgery, Monash University, Melbourne, Australia.,National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia
| | - Heather K Moriarty
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.,Department of Trauma, Alfred Health, Melbourne, Victoria, Australia
| | - Tuan D Phan
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
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17
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Expert consensus on interventional therapy for traumatic splenic bleeding. J Interv Med 2020; 3:109-117. [PMID: 34805919 PMCID: PMC8562271 DOI: 10.1016/j.jimed.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study aims to introduce the diagnosis and treatment processes of traumatic splenic bleeding and explain its emergency, medical, interventional, and surgical treatments. Furthermore, this study aims to summarize the indications and contraindications of splenic artery embolization, interventional procedures, and precautions of complications.
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18
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Patil MS, Goodin SZ, Findeiss LK. Update: Splenic Artery Embolization in Blunt Abdominal Trauma. Semin Intervent Radiol 2020; 37:97-102. [PMID: 32139975 DOI: 10.1055/s-0039-3401845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The spleen is the most commonly injured organ after blunt abdominal trauma. Nonoperative management with splenic arterial embolization (SAE) is the current standard of care for hemodynamically stable patients. Current data favor the use of proximal and coil embolization techniques in adults, while observation is suggested in the pediatric population. In this review, the authors describe the most recent evidence informing the clinical indications, techniques, and complications for SAE.
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Affiliation(s)
- Mangaladevi S Patil
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Sean Z Goodin
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Laura K Findeiss
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
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19
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Davies J, Wells D. Splenic artery embolisation in trauma: A five-year single-centre experience at a UK major trauma centre. TRAUMA-ENGLAND 2019. [DOI: 10.1177/1460408618781412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
IntroductionSince the introduction of major trauma centres and regional trauma networks in 2012, management of splenic injury has shifted, with non-operative management now favoured. For those requiring intervention, splenic artery embolisation is well established as a first-line treatment in all but the most severely injured. Follow-up is variable, with few guidelines, highlighting the paucity of data addressing the need for further imaging and antimicrobial prophylaxis. This review was undertaken to assess practice and outcomes at our centre in the context of the contemporary literature.MethodsThis retrospective study captured splenic embolisations over five years (January 2012–December 2016). CRIS interventional radiology codes were used to retrieve embolisation cases and Trauma Audit and Research Network and hospital event statistics data were used to identify all cases of traumatic splenic injury and to identify splenectomy and non-operative management patients. Outcomes were compared with available standards from different sources.ResultsOver the study period 176 splenic injuries were identified, of which 122 underwent non-operative management, 28 were laparotomy first, and 26 undergoing embolisation with an increased trend to an ‘embolisation-first’ approach over this time. In the embolisation group, the age range was 16–79 yr (mean 41), 18 were male and the median time to intervention was 2 h 9 min (range 1.1–171 h), with eight following failed non-operative management. The proportion of proximal versus selective embolisation versus both was 10:14:1 and the predominant mechanism was coiling. One patient was not embolised due to absence of contrast extravasation on initial angiogram and two proceeded to splenectomy due to failure of splenic artery embolisation. There were complications in six patients: five ongoing left upper quadrant pain, one infected haematoma requiring drainage, two chest infections with pleural effusions, one of which required drainage. There were two deaths from other injuries. Fifteen of the 25 patients who underwent splenic artery embolisation had follow-up imaging, seven did not and three were excluded due to splenectomy and/or death; five patients were vaccinated according to the hospital splenectomy protocol, and six received prophylactic antibiotics.ConclusionOur data show that non-operative management is the mainstay of treatment for the majority of splenic injury patients. Serious complications are not common but variation does exist in follow-up. The changing management trends are in line with national data. These findings will help to further implement and develop local protocols but more work is required to address splenic function after embolisation and the requirement for antimicrobial prophylaxis.
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Affiliation(s)
- James Davies
- Department of Interventional Radiology, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - David Wells
- Department of Interventional Radiology, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
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20
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Unusual Case of Life-Threatening Gastro Intestinal Bleed from a Splenic Artery Pseudoaneurysm: Case Report and Review of Literature. Case Rep Gastrointest Med 2019; 2019:8528906. [PMID: 30881708 PMCID: PMC6381554 DOI: 10.1155/2019/8528906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/17/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022] Open
Abstract
Large upper gastro intestinal (GI) bleeding can be life-threatening. Splenic artery pseudoaenurysm (SAP) is rare but can cause massive upper GI bleeding. We report a case of a 57-year-old woman who had massive upper GI bleeding from SAP eroding into distal duodenum. Literature review shows SAP can bleed into stomach or pancreatic pseudocyst or biliary tree and peritoneal cavity; however, there are no previous reported cases of SAP bleeding into distal duodenum. Splenic artery embolization (SAE) is the preferred treatment for a bleeding SAP. Splenic infarcts can result following a SAE.
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21
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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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22
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Loya MF, Mangat S, Santoro GC, Martynov A, Shah SS. Prophylactic absorbable gelatin sponge embolization for angiographically occult splenic hemorrhage. Radiol Case Rep 2018; 13:753-758. [PMID: 30065796 PMCID: PMC6066598 DOI: 10.1016/j.radcr.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/04/2018] [Indexed: 01/01/2023] Open
Abstract
Nonoperative management of traumatic splenic hemorrhage includes the targeted administration of embolic agents. In certain instances where computed tomography angiography cannot exclude a bleed, prophylactic embolization with absorbable gelatin sponge has been used. In this retrospective case series review, we characterized the demographic data and clinical outcomes associated with 4 patients who underwent prophylactic transarterial splenic artery embolization after blunt abdominal trauma. Embolization was employed in cases where computed tomography angiography findings suggested at least a moderate splenic injury, and simultaneously where hemorrhage was not apparent during fluoroscopic angiography. Periprocedural hemodynamic status, technical success, and postoperative complications are discussed. The goal of this report was to discuss the safety and efficacy of prophylactic gelatin sponge embolization for occult splenic hemorrhage. In cases where a hemorrhagic site might be occult, this approach has the potential to minimize bleeding complications and the need for further intervention.
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Affiliation(s)
- Mohammed F Loya
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Suneet Mangat
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Giovanni C Santoro
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY 11568, USA
| | - Alexander Martynov
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Salman S Shah
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
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23
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Jambon E, Hocquelet A, Petitpierre F, Le Bras Y, Marcelin C, Dubuisson V, Grenier N, Cornelis F. Proximal embolization of splenic artery in acute trauma: Comparison between Penumbra occlusion device versus coils or Amplatzer vascular plug. Diagn Interv Imaging 2018; 99:801-808. [PMID: 29910169 DOI: 10.1016/j.diii.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/14/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare intervention duration and fluoroscopy time for proximal embolization of splenic arteries in acute trauma using the Penumbra occlusion device (POD®), coils or Amplatzer™ vascular plug (AVP). MATERIAL AND METHODS A total of 29 patients with splenic injury without vascular injury who were treated by proximal splenic artery embolization using POD® (n=12), coils (n=9) or AVP (n=8) were retrospectively included. There were 25 men and 4 women with a median age of 34 years (range: 10-69 years). To overcome bias in treatment choice, a propensity score was used using inverse probability weighting. Intervention duration and fluoroscopy time, treatment success and complications were compared. RESULTS The median intervention duration was significantly shorter using POD® (30min) or AVP (47min) than using coils (60min) (P=0.0001 and 0.004, respectively). The median fluoroscopy time was significantly lower using POD® (11.5min) than using coils (23.6min) (P=0.0076) or AVP (16.5min) (P=0.049). The primary efficacy rate was 100% with POD® and AVP and 89% with coils (P=0.586). Six complications occurred with a mean follow-up of 12 months for POD®, 32 months for coils and 40 months for AVP, consisting in 2 abscesses treated by anti-biotherapy with POD®, one abscess with AVP, 2 material migrations with coils and 1 coil dismantled without consequence. CONCLUSION POD® and AVP allow proximal embolization of splenic artery in acute trauma with shorter intervention duration by comparison with conventional metallic coils with similar technical success. POD® allows a shorter fluoroscopy time than coils or AVP.
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Affiliation(s)
- E Jambon
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France.
| | - A Hocquelet
- Department of Radiology, Haut-Leveque University Hospital Center, avenue Magellan, 33600 Pessac, France; Department of Radiology, University Hospital Center, 46, rue du Bugnon, 1011 Lausanne, Switzerland
| | - F Petitpierre
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France
| | - Y Le Bras
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France
| | - C Marcelin
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France
| | - V Dubuisson
- Department of Surgery, Pellegrin Hospital, place Amélie Raba Léon, 33076 Bordeaux, France
| | - N Grenier
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France
| | - F Cornelis
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France; Department of Radiology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Non-surgical Management of Blunt Splenic Trauma: A Comparative Analysis of Non-operative Management and Splenic Artery Embolization—Experience from a European Trauma Center. Cardiovasc Intervent Radiol 2018; 41:1324-1332. [DOI: 10.1007/s00270-018-1953-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/30/2018] [Indexed: 12/12/2022]
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