The Collateral Arterial Network of the Spleen following Ligation of the Splenic Artery in Traumatic Rupture of the Spleen; an Arteriographic Study

Keramidas, D.C.; Kelekis, Dimitrios; Dolatzas, Th.; Aivazoglou, Th.; Voyatzis, N.

doi:10.1055/s-2008-1044169

Cited by 13 publications

(14 citation statements)

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“…PSAE involves occluding the proximal splenic artery using coils or, in some specific situations, using the Amplatzer ® vascular plug. It often can be performed using standard 4- to 5-French catheters and is usually less time-consuming than distal embolization [73, 74]. The technique of selective distal embolization (patient B; Figs.…”

Section: Diagnosticsmentioning

confidence: 99%

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

Vlies

Delden

Punt

et al. 2010

Cardiovasc Intervent Radiol

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IntroductionThe spleen is the second most frequently injured organ following blunt abdominal trauma. Trends in management have changed over the years. Traditionally, laparotomy and splenectomy was the standard management. Presently, nonoperative management (NOM) of splenic injury is the most common management strategy in hemodynamically stable patients. Splenic injuries can be managed via simple observation (OBS) or with angiography and embolization (AE). Angio-embolization has shown to be a valuable alternative to observational management and has increased the success rate of nonoperative management in many series.DiagnosticsImproved imaging techniques and advances in interventional radiology have led to a better selection of patients who are amenable to nonoperative management. Despite this, there is still a lot of debate about which patients are prone to NOM.Angiography and EmbolizationThe optimal patient selection is still a matter of debate and the role of CT and angio-embolization has not yet fully evolved. We discuss the role of sonography and CT features, such as contrast extravasation, pseudoaneurysms, arteriovenous fistulas, or hemoperitoneum, to determine the optimal patient selection for angiography and embolization. We also review the efficiency, technical considerations (proximal or selective embolization), logistics, and complication rates of AE for blunt traumatic splenic injuries.

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Section: Diagnosticsmentioning

confidence: 99%

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

Vlies

Delden

Punt

et al. 2010

Cardiovasc Intervent Radiol

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“…In experimental studies, an increased arterial collateral network was detected at angiography after ligation and embolization of the main splenic artery after 2-4 months [16,30]. Another angiographic follow-up study after ligation of the splenic artery in four children revealed collaterals from the short gastric arteries, the left gastroepiploic artery, and splenic capsule arteries 20 days to 4 months after operation [15]. The significant increase in RI, S/D ratio, and AC at intermediate and late follow-up in our study is probably explained by this increase in collateral circulation.…”

Section: Discussionmentioning

confidence: 92%

“…Angiography immediately after embolization determines the technical success of the procedure. It is assumed that the underlying effect of the flow preservation is formation of collaterals as shown in experimental angiographic studies and some case reports in pediatric patients after ligation of the splenic artery [15,16].…”

Section: Introductionmentioning

confidence: 99%

Intraparenchymal Doppler ultrasound after proximal embolization of the splenic artery in trauma patients

et al. 2008

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We studied the changes in proximal embolization of the splenic artery to the intraparenchymal blood flow with Doppler ultrasound. Seventeen trauma patients with spleen injury OIS grade 2-5 underwent embolization of the splenic artery. Peak-systolic velocity (PSV) and end-diastolic velocity (EDV) were measured in intrasplenic arteries initially 1 day after embolization, at early follow-up after 7 days, at intermediate follow-up after 10 weeks, and at late follow-up after 10 months. Resistance index (RI), systolic/diastolic ratio (S/D ratio), acceleration (AC), and acceleration time (AT) were calculated. The results were compared to values from 17 volunteers. RI increased from 0.39 initially to 0.49 (P = 0.002) at intermediate and to 0.52 (P < 0.001) at late follow-up. S/D ratio increased from 1.68 initially to 1.99 (P = 0.002) and to 2.10 (P < 0.001) at intermediate and late follow-up, respectively. Follow-up results of RI and S/D ratio differed significantly from the reference group. AC increased from 1.06 m/s(2) initially to 1.89 m/s(2) at late follow-up (P = 0.01). AC at late follow-up was not different from reference group (2.33 m/s(2)). In conclusion, Doppler ultrasound is a useful tool in the evaluation of improvable intraparenchymal blood flow over time after central splenic artery embolization.

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“…The end point of proximal embolization, as in surgical artery ligation, is to reduce the splenic bleeding by decreasing blood flow in the main splenic trunk [14] SAE allows reduction in the intrasplenic arterial blood pressure, a condition that may help clots to organize and the spleen to heal [15]. Moreover, it is theorized that proximal embolization allows the spleen to remain, at least partially, perfused by collaterals, thus, limiting the risk of splenic infarction [16]. A series of CT examinations of embolized spleens has shown proximal embolization to be associated with less frequent and smaller infarcts than distal embolization [17].…”

Section: Discussionmentioning

confidence: 99%

Role of Splenic Artery Embolization in Management of Traumatic Splenic Injuries: A Prospective Study

et al. 2012

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The objective of our study was to evaluate the role of splenic artery embolization (SAE) in the management of traumatic splenic injuries. From September 2008 to September 2010, a total of 67 patients underwent nonoperative management (NOM) for blunt splenic injuries. Twenty-two patients were excluded from the study because of associated significant other organ injuries. Twenty-five patients underwent SAE followed by NOM (group A) and 20 patients underwent standard NOM (group B). Improvement in clinical and laboratory parameters during hospital stay were compared between two groups using Chi-square test and Mann-Whitney test. SAE was always technically feasible. The mean length of the total hospital stay was lower in the group A patients (5.4 vs. 6.6 day, [P = 0.050]). There was significant increase in hemoglobin and hematocrit levels and systolic blood pressure (SBP) in group A patients after SAE, whereas in group B patients there was decrease in hemoglobin and hematocrit levels and only slight increase in SBP (pre- and early posttreatment relative change in hemoglobin [P = 0.002], hematocrit [P = 0.001], and SBP [P = 0.017]). Secondary splenectomy rate was lower in group A (4 % [1/25] vs. 15 % [3/20] [P = 0.309]). No procedure-related complications were encountered during the hospital stay and follow-up. Minor complications of pleural effusion, fever, pain, and insignificant splenic infarct noted in 9 (36 %) patients. SAE is a technically feasible, safe, and effective method in the management of splenic injuries. Use of SAE as an adjunct to NOM of splenic injuries results improvement in hemoglobin, hematocrit levels, and SBP. SAE also reduces secondary splenectomy rate and hospital stay.

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The Collateral Arterial Network of the Spleen following Ligation of the Splenic Artery in Traumatic Rupture of the Spleen; an Arteriographic Study

Cited by 13 publications

References 0 publications

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

Intraparenchymal Doppler ultrasound after proximal embolization of the splenic artery in trauma patients

Role of Splenic Artery Embolization in Management of Traumatic Splenic Injuries: A Prospective Study

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