The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries: A systematic review and meta-analysis

Crichton, James; Naidoo, Khimara; Yet, Barbaros; Brundage, Susan I.; Perkins, Zane

doi:10.1097/ta.0000000000001649

Cited by 74 publications

(55 citation statements)

References 61 publications

(114 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the more recent case study of mitral valve replacement for IE by Shafi et al, 25 with hemodynamic stability and moderate to severe splenic injury. [2][3][4][5][6][7][10][11][12] While the use of SAE in atraumatic splenic rupture is supported by a growing number of case studiesincluding the rare case of post-operative splenic rupture post cardiac surgery for IE -, 25 the role of SAE in atraumatic injury has not specifically been defined. [17][18][19][20][21][22][23][24] Further research is needed to understand which conditions resulting in splenic rupture may be best suited for treatment with embolization, as well as when to intervene in these cases, what criteria to base intervention on and which embolization technique may be of most benefit.…”

mentioning

confidence: 99%

“…Over the last few decades there has been a shift to non‐operative management with the goal of splenic salvage. While opinions do still vary, it is general consensus in the interventional radiology and surgical literature, that hemodynamically unstable patients with splenic injury should be treated with operative management while those who are hemodynamically stable will benefit most from non‐operative management (NOM) strategies 2‐7 …”

mentioning

confidence: 99%

See 1 more Smart Citation

Splenic artery embolization for atraumatic splenic rupture

Miller

2020

J Card Surg

View full text Add to dashboard Cite

mentioning

confidence: 99%

mentioning

confidence: 99%

Splenic artery embolization for atraumatic splenic rupture

Miller

2020

J Card Surg

View full text Add to dashboard Cite

“…In 2013, Cirocchi et al performed a systematic review and concluded that they could not clarify the safety and efficacy of NOM for severe splenic trauma because of the selection bias and heterogeneity of the studies [ 3 ]. In 2017, Crichton and his colleagues compared the effectiveness of AE as an adjunct to NOM with that of NOM alone in all grade BSI and concluded that AE significantly improves the success of NOM of AAST grade IV and V BSIs [ 4 ]. As seen above, once NOM was selected for high-grade BSI, AE should be performed, although safety of NOM for high-grade BSI is controversial.…”

Section: Discussionmentioning

confidence: 99%

Failure of Nonoperative Management following Angioembolization for Blunt Splenic and Pancreatic Tail Injury

Nishida¹,

Kubota²

2020

Case Reports in Emergency Medicine

View full text Add to dashboard Cite

Background. Over several decades, standard management of blunt spleen injury (BSI) has been changed from operative intervention to the selective operative and nonoperative management (NOM). However, some patient needs laparotomy first. This article describes a case of a BSI patient who failed nonoperative management after angioembolization (AE). Case Presentation. A 58-year-old man fell from his motorcycle and was brought to our hospital. His vital sign was stable after extracellular fluid bolus. A contrast-enhanced computed tomography scan of the abdomen showed AAST grade V spleen injury. AE was performed for the splenic artery, but his systolic blood pressure suddenly dropped under 60 mmHg. The resuscitative endovascular balloon occlusion of the aorta was inserted, and immediate laparotomy was performed. A pancreatic tail injury was detected, and the splenic artery and vein were burst at the pancreatic tail and controlled by hemostatic suture. After splenectomy, a drain was placed at the pancreatic tail and the abdomen was temporally closed. The postoperative course was not remarkable except for abdominal abscess treated with antibiotics, and he was discharged on foot. Conclusion. Although NOM is becoming one of the choices for severe BSI, there will still be a patient who requires surgery. Surgeons should be aware of the mechanism of injury and the limitation of AE as an adjunct to NOM. Patient selection for initial NOM and timing to convert to laparotomy are important.

show abstract

“…Some trauma centers may have a hybrid operating room with an integrated angiographic suite (54). A recent meta-analysis of hemodynamically stable patients with splenic injury showed no overall difference between nonsurgical treatment success with or without splenic angioembolization, but patients with grade IV or V injuries had significantly fewer instances in which nonsurgical treatment was unsuccessful when splenic angioembolization was performed (11,55). To our knowledge, persistent mesenteric hemorrhage after DCS has not been reported in the literature but can be encountered (Fig 16, Movie 6).…”

Section: Ongoing Hemorrhagementioning

confidence: 99%

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

et al. 2019

View full text Add to dashboard Cite

After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients.

show abstract

The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries: A systematic review and meta-analysis

Abstract: Systematic review and meta-analysis, level III.

Cited by 74 publications

References 61 publications

Splenic artery embolization for atraumatic splenic rupture

Splenic artery embolization for atraumatic splenic rupture

Failure of Nonoperative Management following Angioembolization for Blunt Splenic and Pancreatic Tail Injury

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

Contact Info

Product

Resources

About