The ligation of the splenic artery in the treatment of traumatic rupture of the spleen

Keramidas, D.C.; Ittleman, Frank P.

doi:10.1097/00005373-198003000-00025

Cited by 9 publications

(13 citation statements)

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“…The intervention consists of ligation of the splenic artery at the splenic hilum, without creating necrosis to the spleen, which remains vascularized through epiploic, short gastric, and transcapsular arteries [45]. This technique might be used in high-grade splenic injury, without extravasation seen, as a preventive treatment of rebleeding.…”

Section: Arterial Hemostatic Embolization Techniquesmentioning

confidence: 99%

“…Placement of macrocoils or large gelfoam fragments in the main splenic artery at the hilar bifurcation, as an equivalent to arterial ligation (Keramidas intervention), should be avoided except in a shattered spleen, or as a prevention of rebleeding, when no extravasation is seen (Fig. 3) [45]. Reducing the pressure in the intrasplenic arteries by a proximal embolization in the main splenic artery might not be sufficient to obtain a permanent hemostasis, and massive splenic gastric wall or pancreatic infarction is a potential complication, when a too proximal embolization was performed.…”

Section: Splenic Injuriesmentioning

confidence: 99%

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Traumatic injuries: radiological hemostatic intervention at admission

Dondelinger¹,

Trotteur²,

Ghaye³

et al. 2002

Eur Radiol

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Blunt trauma victims and selected patients with penetrating trauma are systematically investigated after resuscitation and hemodynamic stabilization with cross-sectional imaging. Computed tomography is a good predictor of the need for hemostatic arteriographic embolization, based on contrast medium extravasation observed on CT. In centers admitting polytrauma patients, the CT and angiography units should be installed together within the emergency environment. Trauma-dedicated interventional radiologists should be on call for optimal patient management. Posttraumatic retroperitoneal and pelvic bleeding is a primary indication for angiographic hemostasis, together with orthopedic fixation of pelvic bone fractures. Angiography should be carried out rapidly, before the patient decompensates for considerable blood loss. In patients with visceral bleeding, arterial embolization can obviate primary surgery or potentializes surgical intervention and contributes to changing hierarchy of injuries to be treated surgically. Failure to achieve primary hemostasis may occur according to the type of specific organ injury and coagulation and metabolic parameters of the patient. Postembolization complications are few and are usually non-life-threatening and rarely carry definitive sequelae.

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Section: Arterial Hemostatic Embolization Techniquesmentioning

confidence: 99%

Section: Splenic Injuriesmentioning

confidence: 99%

Traumatic injuries: radiological hemostatic intervention at admission

Dondelinger¹,

Trotteur²,

Ghaye³

et al. 2002

Eur Radiol

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Section: Discussionmentioning

confidence: 99%

“…Among these methods, splenic artery ligation has been reported to be successful by many authors [3,6,7,18]. Keramidas [7] described the follow-up with arteriography after splenic artery ligation in humans showing a newly developed collateral arterial network to the spleen. From the experimental studies in piglets by Pabst et al [15], where the main vessels to the spleen were ligated and cut, leaving the vessels in the gastrolineal ligament and the short gastric vessels intact, a normalsized spleen with enlarged vessels in the gastrolienal ligaments was seen after 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…Splenic salvage became an entity of its own, and a variety of methods have been suggested: topical hemostatics, splenorrhaphy, partial splenectomy, reimplantation of splenic tissue, partial dearterialization and embolization. Ligation of the splenic artery combined with splenorrhaphy has also been successful in obtaining hemostasis [3,6,7,18].…”

Section: Introductionmentioning

confidence: 99%

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Influence of dextran on pneumococcal septicemia in splenic artery-ligated or splenectomized rats

1987

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Splenic artery ligation is one of several methods in splenic preservation. In this experimental work the susceptibility of splenectomized rats and rats treated with splenic artery ligation to pneumococcal infection and the influence of the plasma expander dextran in the same groups were studied. The mortality among splenectomized rats was 100% vs nil after sham operation. Animals treated with splenic artery ligation and saline had a 23% mortality in pneumococcal septicemia, significantly different (P less than 0.05) from the 59% mortality after splenic artery ligation and dextran. A significant increase (P less than 0.05) in number of abscesses was also seen among rats given dextran.

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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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The ligation of the splenic artery in the treatment of traumatic rupture of the spleen

Cited by 9 publications

References 0 publications

Traumatic injuries: radiological hemostatic intervention at admission

Traumatic injuries: radiological hemostatic intervention at admission

Influence of dextran on pneumococcal septicemia in splenic artery-ligated or splenectomized rats

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

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