|
1
|
Boscà-Ramon A, Ratnam L, Cavenagh T, Chun JY, Morgan R, Gonsalves M, Das R, Ameli-Renani S, Pavlidis V, Hawthorn B, Ntagiantas N, Mailli L. Impact of site of occlusion in proximal splenic artery embolisation for blunt splenic trauma. CVIR Endovasc 2022; 5:43. [PMID: 35986797 PMCID: PMC9391208 DOI: 10.1186/s42155-022-00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Proximal splenic artery embolisation (PSAE) can be performed in stable patients with Association for the Surgery of Trauma (AAST) grade III-V splenic injury. PSAE reduces splenic perfusion but maintains viability of the spleen and pancreas via the collateral circulation. The hypothesized ideal location is between the dorsal pancreatic artery (DPA) and great pancreatic artery (GPA). This study compares the outcomes resulting from PSAE embolisation in different locations along the splenic artery. Materials and methods Retrospective review was performed of PSAE for blunt splenic trauma (2015–2020). Embolisation locations were divided into: Type I, proximal to DPA; Type II, DPA-GPA; Type III, distal to GPA. Fifty-eight patients underwent 59 PSAE: Type I (7); Type II (27); Type III (25). Data was collected on technical and clinical success, post-embolisation pancreatitis and splenic perfusion. Statistical significance was assessed using a chi-squared test. Results Technical success was achieved in 100% of cases. Clinical success was 100% for Type I/II embolisation and 88% for Type III: one patient underwent reintervention and two had splenectomies for ongoing instability. Clinical success was significantly higher in Type II embolisation compared to Type III (p = 0.02). No episodes of pancreatitis occurred post-embolisation. Where post-procedural imaging was obtained, splenic perfusion remained 100% in Type I and II embolisation and 94% in Type III. Splenic perfusion was significantly higher in the theorized ideal Type II group compared to Type I and III combined (p = 0.01). Conclusion The results support the proposed optimal embolisation location as being between the DPA and GPA.
Collapse
|
|
2
|
Clinical Results of Distal Embolization in Grade V Splenic Injury: Four-Year Experience from a Single Regional Trauma Center. J Vasc Interv Radiol 2020; 31:1570-1577.e2. [PMID: 32340865 DOI: 10.1016/j.jvir.2020.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the benefits and risks of splenic artery embolization (SAE) in patients with American Association for the Surgery of Trauma (AAST) grade V blunt spleen injury (BSI) MATERIALS AND METHODS: Medical records of 88 patients treated with SAE between April 2013 and May 2017 at a regional trauma care center were reviewed retrospectively. The BSI grade according to the AAST spleen injury scale (revised version 2018) was determined by using computed tomography (CT) images. A total of 42 patients (46.6%) had AAST grade V injury and were included in the analysis. Patient demographics, angiographic findings, embolization techniques, and technical and clinical outcomes, including splenic salvage rate and procedure-related complications, were examined. RESULTS SAE was performed within 2 hours after admission for 78.5% of the patients. All patients underwent selective distal embolization (n = 42). Primary clinical success rate was 80.9% (n = 34), and secondary clinical success rate was 88.1% (n = 37). The clinical failure group consisted of 5 patients. Four patients underwent splenectomy, and 1 patient died due to acute respiratory distress syndrome after embolization. The splenic salvage rate was 85.7% (n = 36). No patient had sepsis at follow-up (median, 247.0 days; interquartile range, 92.0-688.0). Clinical success rates (P = .356) and spleen salvage rates (P = .197) of patients who were hemodynamically stable (n = 19) showed no significant differences from those who were unstable (n = 23). CONCLUSIONS Distal embolization of grade V BSI is a safe and feasible procedure which is effective for successful spleen salvage.
Collapse
|
|
3
|
Rialon KL, Englum BR, Gulack BC, Guevara CJ, Bhattacharya SD, Shapiro ML, Rice HE, Scarborough JE, Adibe OO. Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population. Am J Surg 2015; 212:786-793. [PMID: 26303881 DOI: 10.1016/j.amjsurg.2015.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 05/31/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Splenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE. METHODS The National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE was performed for high-grade injuries using propensity analysis and inverse probability weighting. RESULTS Of 11,694 children presenting with splenic trauma, over 90% were treated nonoperatively. Adjusted analysis of high-grade injuries included 265 children who underwent splenectomy and 199 who underwent SAE. The Injury Severity Score, number of transfusions, and complications rates were not significantly different between the 2 groups. Overall adjusted mortality for children with high-grade injuries was 13.4% following splenectomy and 10.0% following SAE (P = .31) CONCLUSION: Patients undergoing SAE for high-grade splenic trauma have comparable morbidity and mortality with splenectomy.
Collapse
Affiliation(s)
- Kristy L Rialon
- Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian R Englum
- Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian C Gulack
- Division of General Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Carlos J Guevara
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Syamal D Bhattacharya
- Division of Pediatric Surgery, Department of Surgery, Vanderbilt Children's Hospital, Nashville, TN, USA
| | - Mark L Shapiro
- Division of Trauma and Critical Care, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Henry E Rice
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, HAFS Building, Room 6680, Durham, NC 27710, USA
| | - John E Scarborough
- Division of Trauma and Critical Care, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Obinna O Adibe
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, HAFS Building, Room 6680, Durham, NC 27710, USA.
| |
Collapse
|
|
4
|
Xu ZJ, Zheng LQ, Pan XN. Partial embolization as re-treatment of hypersplenism after unsuccessful splenic artery ligation. World J Gastroenterol 2015; 21:1365-1370. [PMID: 25632215 PMCID: PMC4306186 DOI: 10.3748/wjg.v21.i4.1365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/03/2014] [Accepted: 09/16/2014] [Indexed: 02/06/2023] Open
Abstract
Ligation of splenic artery (LSA) is used for the treatment of liver cirrhosis with hypersplenism. However, hypersplenism is not significantly improved following LSA treatment in some cases, and there are few reports of retreatment of hypersplenism after LSA. We report the case of a 47-year-old man with liver cirrhosis and hypersplenism who underwent LSA treatment, but did not significantly improve. Laboratory tests revealed severe leukocytopenia and thrombocytopenia. Celiac computed tomography arteriogram and digital subtraction angiography revealed two compensatory arteries connected to the hilar splenic artery from the left gastro-epiploic artery and from the dorsal pancreatic artery. Partial splenic embolization (PSE) was performed through the compensatory arteries. As a result, the patient achieved partial splenic ischemic infarction, and white blood cell and platelet counts rose and remained in the normal range. PSE is an effective therapeutic modality for the retreatment of hypersplenism when other modalities have failed.
Collapse
|
|
5
|
Jafferbhoy S, Chantry A, Atkey N, Turner D, Wyld L. Spontaneous splenic rupture: an unusual presentation of CML. BMJ Case Rep 2011; 2011:2011/mar16_1/bcr0220113879. [PMID: 22699470 DOI: 10.1136/bcr.02.2011.3879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47-year-old man presented with sudden onset of severe, generalised abdominal pain and collapse. He also had a 4-month history of lethargy and weight loss. On examination he was shocked with a distended tender abdomen. He had haemoglobin of 3.8 g/dl and a white cell count count of 280.3×10(9)/l with predominance of neutrophils. Arterial gases showed mixed metabolic-respiratory acidosis. A CT scan of abdomen showed active extravasation in splenic bed. In view of probable hyperviscosity syndrome, it was decided to attempt an angiographic embolisation. This was successfully carried out but 4 h later, he developed abdominal compartment syndrome and underwent a laparotomy and splenectomy. Subsequently, bone marrow aspirates were taken which showed granulocytic hyperplasia. Cytogenetic studies confirmed the presence of Philadelphia Chromosome and he was started on Imatinib. It is now 5 months since diagnosis and he has achieved complete haematological and cytogenetic response.
Collapse
Affiliation(s)
- Sadaf Jafferbhoy
- Department of General Surgery, Royal Hallamshire Hospital, Sheffield, UK.
| | | | | | | | | |
Collapse
|
|
6
|
Literature review of the role of ultrasound, computed tomography, and transcatheter arterial embolization for the treatment of traumatic splenic injuries. Cardiovasc Intervent Radiol 2010; 33:1079-87. [PMID: 20668852 PMCID: PMC2977075 DOI: 10.1007/s00270-010-9943-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 06/14/2010] [Indexed: 11/05/2022]
Abstract
Introduction The 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. Diagnostics Improved 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 Embolization The 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.
Collapse
|
|
7
|
Zmora O, Kori Y, Samuels D, Kessler A, Schulman CI, Klausner JM, Soffer D. Proximal Splenic Artery Embolization In Blunt Splenic Trauma. Eur J Trauma Emerg Surg 2008; 35:108. [DOI: 10.1007/s00068-008-8030-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
|
|
8
|
Intraparenchymal Doppler ultrasound after proximal embolization of the splenic artery in trauma patients. Eur Radiol 2008; 18:1224-31. [DOI: 10.1007/s00330-008-0860-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 11/18/2007] [Accepted: 01/02/2008] [Indexed: 11/30/2022]
|
|
9
|
Abstract
The surgical care of patients has evolved over the last 50 years. Operative intervention in the face of blunt spleen injury has been supplanted by non-operative techniques. Two of the newest techniques, angiography and embolisation, are reviewed in this article with references to patient selection, technique used and outcomes. Furthermore, current weaknesses in the data available are discussed in order to provide surgeons with a complete overview of the techniques.
Collapse
Affiliation(s)
- WP Klapheke
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - BG Harbrecht
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA,
| |
Collapse
|
|
10
|
Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). ACTA ACUST UNITED AC 2004; 72:1127-34. [PMID: 15345974 DOI: 10.1097/ta.0b013e3182569849] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Thoracic ultrasound (EFAST) has shown promise in inferring the presence of post-traumatic pneumothoraces (PTXs) and may have a particular value in identifying occult pneumothoraces (OPTXs) missed by the AP supine chest radiograph (CXR). However, the diagnostic utility of hand-held US has not been previously evaluated in this role. METHODS Thoracic US examinations were performed during the initial resuscitation of injured patients at a provincial trauma referral center. A high frequency linear transducer and a 2.4 kg US attached to a video-recorder were used. Real-time EFAST examinations for PTXs were blindly compared with the subsequent results of CXRs, a composite standard (CXR, chest and abdominal CT scans, clinical course, and invasive interventions), and a CT gold standard (CT only). Charts were reviewed for in-hospital outcomes and follow-up. RESULTS There were 225 eligible patients (207 blunt, 18 penetrating); 17 were excluded from the US examination because of battery failure or a lost probe. Sixty-five (65) PTXs were detected in 52 patients (22% of patients), 41 (63%) being occult to CXR in 33 patients (14.2% whole population, 24.6% of those with a CT). The US and CXR agreed in 186 (89.4%) of patients, EFAST was better in 16 (7.7%), and CXR better in 6 (2.9%). Compared with the composite standard, the sensitivity of EFAST was 58.9% with a likelihood ratio of a positive test (LR+) of 69.7 and a specificity of 99.1%. Comparing EFAST directly to CXR, by looking at each of 266 lung fields with the benefit of the CT gold standard, the EFAST showed higher sensitivity over CXR (48.8% versus 20.9%). Both exams had a very high specificity (99.6% and 98.7%), and very predictive LR+ (46.7 and 36.3). CONCLUSION EFAST has comparable specificity to CXR but is more sensitive for the detection of OPTXs after trauma. Positive EFAST findings should be addressed either clinically or with CT depending on hemodynamic stability. CT should be used if detection of all PTXs is desired.
Collapse
|
|
11
|
Killeen KL, Shanmuganathan K, Boyd-Kranis R, Scalea TM, Mirvis SE. CT findings after embolization for blunt splenic trauma. J Vasc Interv Radiol 2001; 12:209-14. [PMID: 11265885 DOI: 10.1016/s1051-0443(07)61827-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine complications after transcatheter embolization for blunt splenic injury as recognized with computed tomography (CT). MATERIALS AND METHODS From March 1997 to January 2000, 80 patients underwent transcatheter embolization after blunt splenic injury, of whom 53 underwent abdominal CT examination before and after embolization. Preembolization CT scans were reviewed to determine grade of injury, and postembolization CT scans were reviewed to identify complications secondary to embolization. Arteriography results were reviewed to determine findings and method and location of embolization. RESULTS Splenic infarcts occurred in 63% of patients after proximal embolization and in 100% of patients after distal embolization. Infarcts after distal embolization tend to be larger and occur just distal to the embolization material, whereas infarcts after proximal embolization tend to be smaller, multiple, and located in the periphery. Most infarcts resolved without sequelae. Seven patients developed gas within an infarct or subcapsular fluid collection. Two collections were drained and found to be sterile and one patient had a splenic abscess at laparotomy. CONCLUSIONS Infarcts are common after splenic embolization. Gas may be present within an infarct after embolization with Gelfoam; however, the presence of air/fluid level is a better predictor of abscess.
Collapse
Affiliation(s)
- K L Killeen
- Department of Diagnostic Radiology, University of Maryland Medical System and Shock Trauma Center, Baltimore 21201-1595, USA
| | | | | | | | | |
Collapse
|
|
12
|
Isomura T, Itoh S, Endo T, Akiyama S, Maruyama K, Ishiguchi T, Ishigaki T, Takagi H. Efficacy of gastric blood supply redistribution by transarterial embolization: preoperative procedure to prevent postoperative anastomotic leaks following esophagoplasty for esophageal carcinoma. Cardiovasc Intervent Radiol 1999; 22:119-23. [PMID: 10094991 DOI: 10.1007/s002709900346] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of preoperative redistribution of gastric blood supply on the prevention of anastomotic leakage following surgical reconstruction of the esophagus. METHODS In 37 patients with esophageal carcinoma, transarterial embolization (TAE) of the left gastric, right gastric, and splenic arteries was preoperatively performed with coils so that gastric blood supply was dependent only on the right gastroepiploic artery. RESULTS In 34 of 37 patients, preoperative redistribution was successfully performed. The gastric tissue blood flow (TBF) of a gastric tube was higher than in 12 nonredistributed patients. Reduction in the gastric TBF during preparation of a gastric tube was 27.5% in successful patients, in contrast to 68.9% in 12 nonredistributed patients (p < 0.005). CONCLUSION Preoperative redistribution by TAE reduced the drop in gastric TBF during preparation of a gastric tube and helped prevent postoperative anastomotic leakage in esophageal reconstruction.
Collapse
Affiliation(s)
- T Isomura
- Department of Radiology, Nagoya University School of Medicine, 65 Turumacho, Showaku, Nagoya 466-0065, Japan
| | | | | | | | | | | | | | | |
Collapse
|
|
13
|
Youmans KR, Hunt GB. Experimental evaluation of four methods of progressive venous attenuation in dogs. Vet Surg 1999; 28:38-47. [PMID: 10025639 DOI: 10.1053/jvet.1999.0038] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the most effective and reliable method for progressive attenuation of single extrahepatic portosystemic shunts in dogs. STUDY DESIGN The effects of the four treatments on femoral vein diameter and histology were compared with controls. ANIMALS Fourteen healthy adult dogs. METHODS Twenty-eight canine femoral veins were subjected to sham surgery (4), partial attenuation using silk (5), cellophane banding (6), ameroid constrictor implantation (5), and intravascular thrombogenic coils (8). Changes in vein diameter were evaluated at weekly intervals using venography. After 6 weeks, the dogs were humanely euthanatized, and histopathology was performed on the femoral veins. RESULTS Only cellophane and ameroid constrictors produced progressive and permanent vein attenuation. Ameroid constrictors produced complete occlusion within 14 days in four of five veins and by 21 days in the fifth vein. Cellophane banding produced slow progressive (but not complete) attenuation in five of six veins. Complete occlusion was demonstrated in four of eight veins after thrombogenic coil implantation; however, recanalization occurred in all but one dog. Perivascular silk did not produce significant progressive attenuation. CONCLUSIONS Ameroid constrictors produced rapid occlusion of femoral veins. Cellophane banding resulted in slower attenuation. Thrombogenic coils produced attenuation, but this was not sustained in many cases. Silk did not promote ongoing attenuation. CLINICAL RELEVANCE Both ameroid constrictor implantation and cellophane banding show promise for progressive attenuation of single extrahepatic portosystemic shunts in dogs. Because rapid occlusion was seen with ameroid constrictors, however, cellophane banding maybe a safer technique in animals with increased hepatic vascular resistance. Further evaluation of both treatments in clinical cases is warranted.
Collapse
Affiliation(s)
- K R Youmans
- Department of Veterinary Clinical Sciences, University of Sydney, Australia
| | | |
Collapse
|
|
14
|
Sclafani SJ, Shaftan GW, Scalea TM, Patterson LA, Kohl L, Kantor A, Herskowitz MM, Hoffer EK, Henry S, Dresner LS. Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. THE JOURNAL OF TRAUMA 1995; 39:818-25; discussion 826-7. [PMID: 7473996 DOI: 10.1097/00005373-199511000-00004] [Citation(s) in RCA: 198] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aims of this study were to determine if angiographic findings can be used to predict successful nonoperative therapy of splenic injury and to determine if coil embolization of the proximal splenic artery provides effective hemostasis. METHODS Splenic injuries detected by diagnostic imaging between 1981 and 1993 at a level I trauma center were prospectively collected and retrospectively reviewed after management by protocol that used diagnostic peritoneal lavage, computed tomography (CT), angiography, transcatheter embolization, and laparotomy. Computed tomography was performed initially or after positive diagnostic peritoneal lavage. Angiography was performed urgently in stabilized patients with CT-diagnosed splenic injuries. Patients without angiographic extravasation were treated by bed rest alone; those with angiographic extravasation underwent coil embolization of the proximal splenic artery followed by bed rest. RESULTS Patients (172) with blunt splenic injury are the subject of this study. Twenty-two patients were initially managed operatively because of associated injuries or disease (11 patients) or because the surgeon was unwilling to attempt nonoperative therapy (11 patients) and underwent splenectomy (17 patients) or splenorrhaphy (5 patients). One hundred fifty of 172 consecutive patients (87%) with CT-diagnosed splenic injury were stable enough to be considered for nonoperative management. Eighty-seven of the 90 patients managed by bed rest alone, and 56 of 60 patients treated by splenic artery occlusion and bed rest had a successful outcome. Overall splenic salvage was 88%. It was 97% among those managed nonoperatively, including 61 grade III and grade IV splenic injuries. Sixty percent of patients received no blood transfusions. Three of 150 patients treated nonoperatively underwent delayed splenectomy for infarction (one patient) or splenic infection (two patients). CONCLUSIONS (1) Hemodynamically stable patients with splenic injuries of all grades and no other indications for laparotomy can often be managed nonoperatively, especially when the injury is further characterized by arteriography. (2) The absence of contrast extravasation on splenic arteriography seems to be a reliable predictor of successful nonoperative management. We suggest its use to triage CT-diagnosed splenic injuries to bed rest or intervention. (3) Coil embolization of the proximal splenic artery is an effective method of hemostasis in stabilized patients with splenic injury. It expands the number of patients who can be managed nonoperatively.
Collapse
Affiliation(s)
- S J Sclafani
- Department of Radiology, State University of New York Health Science Center at Brooklyn, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
15
|
Kearse WS, Joseph AE, Sabanegh ES. Transcatheter embolization of large idiopathic renal arteriovenous fistula. J Urol 1994; 151:967-9. [PMID: 8126838 DOI: 10.1016/s0022-5347(17)35136-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Renal arteriovenous fistulas are unusual lesions with a variety of clinical manifestations. Congenital and acquired forms have been treated successfully with transcatheter embolization for 2 decades. In the case of large aneurysmal lesions the risk of inadvertent pulmonary embolism has traditionally precluded this approach and necessitated open surgery. However, with refinements in angiographic equipment and technique, such an approach is now feasible and desirable.
Collapse
Affiliation(s)
- W S Kearse
- Department of Urology, Wilford Hall Medical Center, San Antonio, Texas 78236-5300
| | | | | |
Collapse
|
|
16
|
Shiina S, Aoyama H, Shiratori Y, Hata Y, Niwa Y, Komatsu Y, Mutoh H, Kurita M, Nakata R, Shimada T. Splenic ablation by percutaneous injection of ethanolamine oleate in dogs: a possible therapy for hypersplenism. GASTROENTEROLOGIA JAPONICA 1989; 24:740. [PMID: 2606310 DOI: 10.1007/bf02774180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- S Shiina
- 2nd Dept. of Internal Medicine, University of Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Latshaw RF, Pearlman RL, Schaitkin BM, Griffith JW, Weidner WA. Intraarterial ethanol as a long-term occlusive agent in renal, hepatic, and gastrosplenic arteries of pigs. Cardiovasc Intervent Radiol 1985; 8:24-30. [PMID: 4016805 DOI: 10.1007/bf02552636] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The renal, hepatic, or gastrosplenic arteries of eleven juvenile pigs were selectively injected intraarterially with 95% ethanol to evaluate its efficacy as an agent for use in permanent occlusion and infarction of the vascular bed supplied by the injected artery. A dose of 2.2 cc/5 kg (1 cc/5 lb) of 95% ethanol was injected over 30-45 sec. The animals were then killed at 1 to 91 days and all pigs demonstrated tissue infarction and vascular occlusion. Our results confirm that ethanol is an effective agent for the infarction of organs and that complications can result if catheter placement is not precise and normal tissue is inadvertently perfused.
Collapse
|
|
18
|
Vujic I, Lauver JW. Severe complications from partial splenic embolization in patients with liver failure. Br J Radiol 1981; 54:492-5. [PMID: 7237027 DOI: 10.1259/0007-1285-54-642-492] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Transcatheter embolization of the spleen is gaining popularity as a non-surgical method of treatment for hypersplenism. While early reports documented frequent serious complications, a more recent study noted good results using a fractionated approach with only partial embolization of the periphery of the spleen. This technique was recently used on three patients with hypersplenism associated with severe liver disease. All had grave complications, including sepsis, pneumonia, abscess formation, and progressive liver failure, and all died within six weeks of the angiographic procedure in spite of good haematological responses. Since it is frequently this category of patient in whom the procedure is attempted, definitive surgical splenectomy is suggested following the embolization as soon as the clotting parameters return to normal.
Collapse
|
|
19
|
Hunt TH, Gelfand DW. Complications of gastrointestinal radiologic procedures: III. Complications of diagnostic and interventional angiography. GASTROINTESTINAL RADIOLOGY 1981; 6:57-67. [PMID: 7021299 DOI: 10.1007/bf01890222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
|
20
|
Gelfand DW, Ott DJ, Hunt TH. Gastrointestinal Complications of Radiologic Procedures. RADIOLOGY OF IATROGENIC DISORDERS 1981. [DOI: 10.1007/978-1-4612-5853-7_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
|
21
|
Abstract
While transcatheter embolization of the spleen has shown promise in the treatment of a wide spectrum of disorders, the incidence of serious complications with this technique has limited its use as an alternative to operative splenectomy. In our institution 41 patients were treated with a modified technique involving partial splenic embolization, careful antibiotic prophylaxis, and adequate pain control. There was no mortality and only few instances of clinically significant complications: a splenic abscess in one patient, pancreatitis in one patient, severe pleural effusions in two patients, and pneumonia in five patients.
Collapse
|
|
22
|
Pond GD, Ovitt TW. Therapeutic applications of angiography: state of the art. Curr Probl Diagn Radiol 1979; 8:1-55. [PMID: 380917 DOI: 10.1016/s0363-0188(79)80004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
|
23
|
Wallace S, Schwarten DE, Smith DC, Gerson LP, Davis LJ. Intrarenal arteriovenous fistulas: transcatheter steel coil occlusion. J Urol 1978; 120:282-6. [PMID: 682242 DOI: 10.1016/s0022-5347(17)57138-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Intrarenal arteriovenous fistulas are either congenital (cirsoid), acquired or idiopathic. Transcatheter occlusion of these fistulas was accomplished using the Gianturco stainless steel coil. The anatomical configuration of the feeding and draining vessels dictated the technical approach. There was considerable conservation of renal tissue as the result of this non-surgical therapeutic alternative.
Collapse
|