Endovascular Management of Complex Splenic Aneurysm with the “Amplatzer” Embolic Platform: Application of Cone-beam Computed Tomography

Kos, Sebastian; Burrill, Joshua; Weir, Graeme; Salat, Peter; Ho, Stephen; Liu, David M.

doi:10.1016/j.carj.2009.11.002

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…Transcatheter splenic artery embolization is an accepted standard of care in the treatment of numerous splenic pathologic processes, including post-traumatic and postinflammatory splenic hemorrhages 3, 4, 5. Two widely accepted methods are used, proximal splenic artery embolization and subtotal (ie, partial) splenic embolization 5 .…”

Section: Discussionmentioning

confidence: 99%

Novel use of the Surefire antireflux device in subtotal splenic embolization

Chung

Cormack

Patel

et al. 2015

Journal of Vascular Surgery Cases

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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. (J Vasc Surg Cases 2015;1:242-5.) Transcatheter embolization is an accepted standard of care in the treatment of numerous visceral pathologic processes ranging from trauma to neoplasia. A unique circumstance arises when a space-occupying entity develops adjacent to and exerts mass effect on a solid organ that requires embolization, such as can be seen when a hemorrhaging renal angiomyolipoma results in a large perinephric hematoma. This may result in elevated parenchymal pressurization of the organ, increasing the likelihood of incomplete embolization as well as nontargeted embolization. We present such a scenario, in which a patient with an enlarging subcapsular splenic hematoma required subtotal splenic embolization, and discuss the novel use of the Surefire antireflux device (Surefire Medical Inc, Westminster, Colo) to overcome the limits of conventional end-hole catheter embolotherapy. The patient's consent for potential publication of his therapy was obtained. CASE REPORTA 50-year-old white male Jehovah's Witness presented to a peripheral hospital with an 8-day history of abdominal pain and in hypovolemic shock. Initial assessment including standard biochemical markers and computed tomography (CT) revealed a history compatible with acute-on-chronic pancreatitis complicated by a large subcapsular splenic hematoma. This is a known albeit rare complication of pancreatitis that has been described in the literature. 1,2 A multiphase CT examination at our institution demonstrated further enlargement of the splenic hematoma, although there was no evidence of active arterial extravasation.Because of ongoing hemodynamic instability, worsening symptoms, enlargement of the hematoma, and a contraindication to splenectomy due to concerns of potential blood loss coupled with the patient's refusal to receive blood products because of his religious beliefs, the decision was made by his clinical team to proceed with pre-emptive subtotal splenic embolization. TECHNIQUEAfter fluid resuscitation, informed consent was obtained and moderate sedation was initiated. The right common femoral artery was accessed, and a 45-cm Ansel 2 vascular sheath (Flexor; Cook Medical Inc, Bloomington, Ind) was placed. A 100-cm C2 glide catheter (Terumo Medical ...

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Section: Discussionmentioning

confidence: 99%

Novel use of the Surefire antireflux device in subtotal splenic embolization

Chung

Cormack

Patel

et al. 2015

Journal of Vascular Surgery Cases

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“…To allow for such advanced image acquisition using an intra-arterially contrast enhanced cone-beam CT, parameters have been described. 42 For example, using a 48-cm field of view, positioning the isocenter of the volume at the tip of the selectively positioned catheter, the contrast media injection rate may be chosen to be 3 cc/second for 8 seconds. Using a 2-to 4-second X-ray delay, and a 3 degree/frame within a single breathhold, a 200-degree arc rotation (with 30 degrees/second) will allow for an adequate acquisition of image raw data.…”

Section: Materials and Techniquementioning

confidence: 99%

Diagnosis and Therapy of Acute Hemorrhage in Patients with Pelvic Fractures

Kos

Gutzeit

Hoppe

et al. 2013

Semin Musculoskelet Radiol

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Within the past 15 years, significant advances in the imaging of multiorgan and complex trauma primarily due to the improvement of cross-sectional imaging have resulted in the optimization of the expedient diagnosis and management of the polytrauma patient. At the forefront, multidetector computed tomography (MDCT) has become the cornerstone of modern emergency departments and trauma centers. In many institutions, MDCT is the de facto diagnostic tool upon trauma activation. In the setting of pelvic imaging, MDCT (with its high spatial resolution and sensitivity as well as short acquisition times) allows for rapid identification and assessment of pelvic hemorrhage leading to faster triage and definitive management. In trauma centers throughout the world, angiography and minimally invasive catheter-based embolization techniques performed by interventional radiologists have become the standard of care for patients with acute pelvic trauma and related multiorgan hemorrhage. In an interdisciplinary setting, embolization may be performed either alone or as an adjunct procedure with open or closed reduction and stabilization techniques. A team-based approach involving multiple disciplines (e.g., radiology, traumatology, orthopedic surgery, intensive care medicine) is crucial to monitor and treat the actively bleeding patient appropriately.

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