complications of left upper quadrant abscess and postprocedural splenic artery hemorrhage were recorded. Results: 86 Splenectomy patients with AAST grading (G), represented by number of complications/total cases (complication rate): G3 1/35 (3%); G4 1/25 (4%); G5 2/26 (8%). 31 SAEs with a combination of Gelfoam, microcoils, and calibrated microspheres were performed on 30 patients: G3 0/13 (0%); G4 3/14 (21%); G5 2/3 (67%). Major complications occurred in 1/19 distal SAEs (5%), a single case with persistent bleeding after SAE requiring splenectomy, and in 4/12 proximal SAEs (33%), including 3 patients with persistent bleeding after SAE requiring splenectomy and one patient with abscess formation. All SAE complications were seen with G4 and G5 injuries only. A Chi-squared analysis shows statistical significance in major complications for G5 injuries comparing SAE versus splenectomy (p ¼ 0.005), and major complications between distal versus proximal SAE (p ¼ 0.033). Conclusions: SAE is safe and effective as observed in previous literature, although with higher major complications observed in proximal embolization and in Grade 4 and 5 lesions compared to surgical management. Complications seen with the angiographic therapy of high grade lesions suggest that initial surgical management may be better in G5 injuries. Therefore, a multidisciplinary approach to BSI is paramount.
Purpose: Embolization of the left gastric artery (LGA) to decrease blood supply to the gastric fundus has been shown to decrease ghrelin levels and result in appetite suppression and weight modulation in animal studies. Ongoing clinical trials in humans have shown promising results, but these studies are limited to small sample sizes. This study aims to establish whether LGA embolization for gastrointestinal bleeding causes unintended weight loss. Herein, we evaluate the safety and efficacy of this procedure in a larger patient cohort. Materials: An IRB approved retrospective study was conducted to identify patients who underwent LGA embolization for gastrointestinal bleeding. Patients with cancer diagnoses were excluded given the potential for confounding. Pre-and postprocedure weight and metabolic parameters including HDL, LDL, triglycerides, and HgbA1c were assessed. Statistical analysis was performed using paired t-test and sign rank test. Results: 39 consecutive patients were identified. The most common embolic used was Gelfoam (n ¼ 20), followed by PVA particles (n ¼ 5) and coils (n ¼ 5). In 21 patients who had documented pre-and post-procedural weights, there was a median of 9.1kg (11.0%) weight loss (p ¼ 0.06). Mean pre-and postprocedure weights were 90.7kg and 81.6kg, respectively, over a median time of 12 months (range, 2-72). There was a mean increase of 20 mg/dL in HDL (n ¼ 9, p ¼ 0.02) over a median time of 11 months (range, 5-60). There was no significant change in LDL, triglycerides or HgbA1c levels. Of patients who had postprocedure endoscopies (n ¼ 10), 80.0% demonstrated mucosal ulcerations within 3 months. The remaining patients had no documented reports of complications related to the procedure. Conclusions: Although weight loss after LGA embolization was not statistically significant, a strong trend was seen despite proximal embolization techniques, lack of weight management and small sample size. Elevation of HDL levels appears to be an unexplained side-effect of LGA embolization. While no clinical toxicity was reported, there was a high incidence of ulceration which were asymptomatic, self-limited and required no additional management.
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