Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries – A level 1 Australian Trauma centre experience

Han, Jennie; Dudi‐Venkata, Nagendra N.; Jolly, Samantha; Ting, Ying Yang; Ha, Lu; Thomas, Meredith; Dobbins, Christopher

doi:10.1016/j.injury.2021.12.043

Cited by 8 publications

(7 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After splenic artery embolisation, the spleen is known to have preserved immune function, 188,189 and no cases of OPSI post SAE have been reported to date 190,191 . In addition, embolisation offers a significantly less invasive treatment approach through a pinhole needle puncture, is lower in cost than splenectomy, has a lower rate of complications, shorter hospital length of stay, and cosmetic advantages 192–195 …”

Section: Discussionmentioning

confidence: 99%

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

Lukies,

Clements

2023

UEG Journal

View full text Add to dashboard Cite

BackgroundSplenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low‐grade injuries or with splenectomy for high‐grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation.MethodsA systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality.ResultsThe 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59–70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81).ConclusionsSplenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

Lukies,

Clements

2023

UEG Journal

View full text Add to dashboard Cite

show abstract

“…Recent studies have shown a growing trend towards using AE as an adjunct to NOM, resulting in higher success rates and better outcomes in terms of mortality, length of hospital stay, and related complications, particularly for high-grade injuries. AE has revolutionized the NOM of blunt abdominal trauma, especially for spleen and liver injuries, offering a safe and feasible approach using established interventional techniques [19–23].…”

Section: Text Of the Reviewmentioning

confidence: 99%

Blunt abdominal trauma: watch and wait

Cioffi,

Cimbanassi,

Chiara

2023

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose This review examines recent advancements in nonoperative management (NOM) of hemodynamically stable blunt abdominal trauma, focusing on expanding patient selection for observation-first strategies, particularly for high-grade solid organ injuries. Recent Findings Advances include a more deliberate nonoperative approach, allowing for broader patient inclusion in diagnostic and interventional angiography. Strict clinical monitoring and appropriate follow-up strategies are crucial to identify early signs of clinical progression and complications. Repeated contrast-enhanced CT (CECT) scan can be used for close observation of high-risk injuries, while the repetition of CECTs may be avoided for lower-risk cases, such as specific high-grade kidney injuries. The role of contrast-enhanced ultrasound (CEUS) in detecting sequelae of nonoperative approaches is still debated and has lot of potential, with ongoing trials exploring possible advantages. Summary Multidisciplinary trauma teams play a crucial role in nonoperative management, particularly for high-grade injuries. A careful selection of patients is essential to minimize failure rates. Complications of nonoperative and angiographic approaches should be managed according to local expertise.

show abstract

“…16 Contrary to these findings, a recent Australian study found that embolization was highly successful for grade III injuries and significantly reduced hospital length of stay when compared with non-operative management alone. 17 Regardless, most authors conclude that, to date, there is no consensus regarding the optimal management of this patient cohort, with multiple available publications and conflicting results. Because new research is available that contradicts the findings of the latest systematic review, 13 there is a need to re-evaluate the literature.…”

Section: Introductionmentioning

confidence: 98%

Non-operative management for high-grade splenic injury: a systematic review protocol

Nann,

Clarke,

Jog

et al. 2023

JBI Evidence Synthesis

View full text Add to dashboard Cite

Objective: The objective of this review is to establish whether embolization is more effective than clinical observation for adult patients with grade III–V splenic injuries. Findings will be used to guide future practice and, if necessary, inform future research design and conduct. Introduction: The spleen is one of the most frequently injured intra-abdominal organs, with a reported adult mortality of 7% to 18% following trauma. Non-operative management has become a standard of care for hemodynamically stable patients. In clinical practice, the decision whether to prophylactically embolize or manage high-grade injuries with observation alone remains controversial. Inclusion criteria: Sources including adult patients with grade III–V splenic injuries secondary to blunt trauma will be included in this review. Eligible studies must include comparisons between 2 cohorts of patients undergoing either prophylactic embolization or clinical observation only. Outcomes will include mortality rate, failure of treatment, intensive care unit admission, length-of-hospital stay, blood transfusion requirements, and patient satisfaction. Methods: A systematic review with meta-analysis will be conducted. PubMed, Embase, and CINAHL will be searched for eligible studies, as will trial registries and sources of gray literature. Study selection, quality appraisal, and outcome data extraction will be performed in duplicate. Methodological quality will be evaluated with appropriate JBI critical appraisal tools. Studies will, where possible, be pooled in statistical meta-analysis. A random effects model will be used and statistical analysis will be performed. The certainty of the findings will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Review registration: PROSPERO CRD42023420220

show abstract

Splenic artery embolization improves outcomes and decreases the length of stay in hemodynamically stable blunt splenic injuries – A level 1 Australian Trauma centre experience

Cited by 8 publications

References 46 publications

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

Blunt abdominal trauma: watch and wait

Non-operative management for high-grade splenic injury: a systematic review protocol

Contact Info

Product

Resources

About