Splenic Embolization Revisited: A Multicenter Review

Haan, James M.; Biffl, Walter L.; Knudson, M. Margaret; Davis, Kimberly A.; Oka, Tomomi; Majercik, Sarah; Dicker, Rochelle; Marder, Shelley R.; Scalea, Thomas M.

doi:10.1097/01.ta.0000114069.73054.45

Cited by 289 publications

(257 citation statements)

References 11 publications

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“…Distal embolisation is often used for the treatment of focal vascular injuries such as pseudoaneurysms or arteriovenous fistulae [4,23]. Subsequent bleeding may occur because some vascular injuries are initially not detected at angiography or CT due to vasospasm [4,23].…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent bleeding may occur because some vascular injuries are initially not detected at angiography or CT due to vasospasm [4,23]. However, a recent meta-analysis found that the only difference in short-term outcomes between the two techniques was a higher rate of splenic infarcts after distal embolisation [10].…”

Section: Discussionmentioning

confidence: 99%

“…Splenic artery embolisation (SAE) has been shown to increase the rate of splenic conservation following trauma, [1][2][3][4][5][6] and is frequently performed as an adjunct to nonoperative management of blunt splenic injury which is now the standard of care in haemodynamically stable patients [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Foley

Kavnoudias

Cameron

et al. 2015

Cardiovasc Intervent Radiol

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Purpose To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Materials and Methods Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. Results Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation-a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. Conclusion IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Foley

Kavnoudias

Cameron

et al. 2015

Cardiovasc Intervent Radiol

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“…The description and prevalence of these complications varies greatly from one series to another (7,(11)(12)(13), resulting from the confusion existing between adverse events related to injury and those related to treatment. The severity of polytrauma is taken into account using the patients' injury severity score (ISS), and several studies have shown that a high ISS was related to more nonsurgical treatment failures (14).…”

mentioning

confidence: 99%

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Frandon¹,

Rodière²,

Arvieux³

et al. 2015

Diagn Interv Radiol

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B lunt splenic injury (BSI) has become more frequently managed nonoperatively over the years, with the results improved by the contribution of embolization, making it possible to treat active hemorrhages as well as prevent hemorrhages in high-grade trauma of the spleen without active bleeding (1-10). Three methods of splenic artery injury management can be defined: operative management (OM), nonoperative management (NOM), and nonoperative management with splenic artery embolization (SAE).The complication rate in relation to different management methods (operative and nonoperative) continues to be debated. The description and prevalence of these complications varies greatly from one series to another (7,(11)(12)(13), resulting from the confusion existing between adverse events related to injury and those related to treatment. The severity of polytrauma is taken into account using the patients' injury severity score (ISS), and several studies have shown that a high ISS was related to more nonsurgical treatment failures (14). Certain authors have taken a specific interest in the parameters of multiple injuries and shown that lesions of associated organs (pancreas, spinal cord, limbs) were related to more complications (15-17). The severity of trauma and associated lesions could therefore be considered confounding factors resulting in treatment failure and complications. A better understanding of these complications could help in preventing them.The objectives of this study were to compare outcomes of the three types of BSI management, determine if there are any complications statistically related to management methods, and demonstrate risk factors taking polytrauma into account. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. RESULTSThe 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. CONCLUSIONPatients 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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“…They have reported rates ranging between 3 and 14 % [50,51]. A recent review over 1085 patients treated by NOM, 88 of whom submitted to angioembolization (AE), reports a complication rate of 14 % after AE.…”

Section: Nom Of the Spleen And Splenic Abscessesmentioning

confidence: 99%

Management of Post-Traumatic Complications by Interventional Ultrasound: a Review

2016

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Purpose of Review We reviewed the current literature to assess the feasibility of ultrasound-assisted and ultrasoundguided procedures for the treatment of post-traumatic complications and to address the indications and techniques of procedures. Recent Findings Non-operative strategies have been introduced in the treatment of severe trauma, and consequently, the incidence of some post-traumatic complications has increased. US can be useful both for the initial assessment of trauma patients and for the treatment of complications. Summary Ultrasound-guided and ultrasound-assisted procedures as a therapeutic tool in the management of post-trauma settings are probably underused, in comparison with their successful use in other acute settings. Some new possible fields of clinical researches are suggested.

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Splenic Embolization Revisited: A Multicenter Review

Abstract: Splenic embolization remains a valuable technique in splenic salvage, especially in higher grade injuries. Complications are common but do not seem to affect outcome.

Cited by 289 publications

References 11 publications

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Management of Post-Traumatic Complications by Interventional Ultrasound: a Review

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