• aneurysms
• cirrhosis
• embolization
• hypersplenism
• portal hypertension
• splenic artery

• Gastrointestinal bleeding
• Pancreatitis
• Pseudoaneurysm

• Humans
• Aneurysm, False/diagnostic imaging
• Aneurysm, False/therapy
• Male
• Splenic Artery/diagnostic imaging
• Aged
• Embolization, Therapeutic
• Tomography, X-Ray Computed
• Pancreatitis/complications
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Abdominal Pain/etiology
• Treatment Outcome

• Asymptomatic
• Growth rate
• Natural history
• Splenic artery
• Splenic artery aneurysm

• Humans
• Female
• Adult
• Middle Aged
• Aged
• Aged, 80 and over
• Adolescent
• Young Adult
• Male
• Follow-Up Studies
• Splenic Artery/diagnostic imaging
• Splenic Artery/surgery
• Aneurysm, Ruptured/surgery
• Retrospective Studies
• Treatment Outcome

• Humans
• Female
• Middle Aged
• Splenic Artery/diagnostic imaging
• Retrospective Studies
• Treatment Outcome
• Aneurysm/therapy
• Aneurysm/surgery
• Endocarditis, Bacterial/diagnostic imaging
• Endocarditis, Bacterial/therapy
• Endocarditis/diagnostic imaging
• Endocarditis/therapy
• Communicable Diseases
• Observational Studies as Topic

• Humans
• Renal Artery/diagnostic imaging
• Radiology, Interventional
• Aneurysm/diagnostic imaging
• Aneurysm/surgery
• Embolization, Therapeutic/adverse effects
• Italy

• Gastric bypass - gastrointestinal bleeding - splenic artery pseudoaneurysm - bariatric surgery - trans-arterial embolization

• embolization
• pancreatitis
• splenic artery pseudoaneurysm

• aneurysm rupture
• ruptured splenic aneurysms
• shock during pregnancy
• splanchnic aneurysms
• splenectomy
• splenic artery aneurysms and pseudoaneurysms
• transarterial artery embolization
• visceral aneurysms

• Arterial embolisation
• Mesenteric
• Renal
• Visceral aneurysm

• coil
• embolization
• endovascular
• pseudoaneurysm

• infective endocarditis
• rheumatic heart disease
• septicemia
• splenic infarction
• streptococcus agalactiae

• detachable coil
• double microcatheter technique
• splenic artery aneurysm

A devastating injury to the liver from a gunshot wound (GSW) challenges the most seasoned trauma surgeon. This challenge is intensified when patients develop severe shock with a high-grade injury. We present the case of a patient with a grade 5 liver injury after a GSW treated with operative and interventional radiology (IR) treatment simultaneously.

A 25-year-old male presented to our Trauma Center with hypotension, after an abdominal GSW. He was taken emergently to the operating room, which revealed a Grade 5 liver injury with massive hemorrhage. Operative intervention was initiated immediately and a non-anatomic left lobectomy with hepatorrhaphy was performed. IR was consulted intra-operatively and performed a left hepatic artery angioembolization. The patient received over 50 units of blood products during the combined procedures, with eventual bleeding control. On post-operative day 33, the patient became acutely hemodynamically unstable, and angiography revealed a splenic artery pseudoaneurysm, which was embolized but re-bled and resulted in splenectomy. The patient eventually recovered and follows up at 1-year revealed a patient doing well.

High-grade liver injuries carry significant mortality. Mortality worsens when severe shock is present. Operative intervention is the standard approach for patients who remain in shock. To help improve outcomes patients may benefit from a combined approach with the interventional radiology team.

The acute management of severe liver injuries when presenting with ongoing shock is beneficial to include both trauma surgeons with interventional radiologists. Further studies are needed to determine the best approach for this devastating injury.

•

Severe hepatic injuries may require both operative management & angioembolization.

• Abdominal
• Aneurysms
• Endovascular
• Rupture
• Visceral

• Splenic trauma
• blunt abdominal trauma
• embolization
• endovascular
• interventional radiology

To assess the safety and efficacy of main splenic artery embolization. To assess the potential difference post-embolization of the residual splenic volume in patients embolized for trauma versus those embolized for (pseudo)aneurysms.

A retrospective analysis was performed on a cohort of 65 patients (36 males) who underwent pre- and post-embolization computed tomography. Patients’ demographics, pre- and post-interventional medical and radiological data were gathered. Splenic volume calculations were semi-automatically performed via a workstation. Patients with splenic aneurysms or pseudoaneurysms of the main splenic artery (group 1) were compared to those with splenic rupture (group 2) using Wilcoxon rank tests.

The main indications for splenic artery embolization were splenic rupture (n = 22; 34%) and splenic pseudoaneurysm (n = 19; 29%). The technical success rate was n = 63; 97%. The procedure-related complication rate was n = 7; 11%, including abscess formation (n = 5; 8%), re-bleeding (n = 1; 1.5 %) and pseudoaneurysm re-opening (n = 1; 1.5%). The overall 30-day mortality was n = 7; 11%.

Median follow-up for groups 1 and 2 was 1163 days (61–3946 days) and 702 days (43–2095 days) respectively. When processable (n = 23), the splenic volume in group 1 (n = 7) was 311 cm³ and 257 cm³ (p = 0.1591) before and after embolization respectively, and in group 2 (n = 16) it was 261 cm³ and 215 cm³ (p = 0.4688), respectively.

Main splenic artery embolization is efficacious, with low procedure-related complication and 30-day mortality rates. No significant differences in residual post-embolization splenic volume were found between patients treated for splenic rupture versus those treated for splenic arterial (pseudo)aneurysm.

• computed tomography
• embolization
• splenic artery
• splenic volume

• aneurysm
• embolization
• endovascular treatment
• renal artery

Pseudoaneurysms (PAs) caused by traumatic injury to the arterial vasculature have a high risk of rupture, leading to life-threatening hemorrhage and mortality, requiring urgent treatment. The purpose of this study was to determine the technical and clinical outcomes of endovascular treatment of visceral and extremity traumatic pseudoaneurysms.

Clinical data were retrospectively collected from all patients presenting for endovascular treatment of PAs between September 2012 and September 2018 at a single academic level one trauma center. Technical success was defined as successful treatment of the PA with no residual filling on post-embolization angiogram. Clinical success was defined as technical successful treatment with no rebleeding throughout the follow-up period and no reintervention for the PA.

Thirty-five patients (10F/25M), average age (± stdev) 41.7 ± 20.1 years, presented with PAs secondary to blunt (n = 31) or penetrating (n = 4) trauma. Time from trauma to intervention ranged from 2 h - 75 days (median: 4.4 h, IQR: 3.5–17.1 h) with 27 (77%) of PAs identified and treated within 24 h of trauma. Average hospitalization was 13.78 ± 13.4 days. Ten patients underwent surgery prior to intervention. PA number per patient ranged from 1 to 5 (multiple diffuse). PAs were located on the splenic (n = 12, 34.3%), pelvic (n = 11, 31.4%), hepatic (n = 9, 25.7%), upper extremity/axilla (n = 2, 5.7%), and renal arteries (n = 1, 2.9%). Technical success was 85.7%. Clinical success was 71.4%, for technical failure (n = 5), repeat embolization (n = 1) or post-IR surgical intervention (n = 4). There was no PA rebleeding or reintervention for any patient after discharge over the reported follow-up periods. Three patients died during the trauma hospitalization for reasons unrelated to the PAs.

Endovascular treatment of traumatic visceral and extremity PAs is efficacious with minimal complication rates and low reintervention requirements.

• Endovascular treatment
• Pseudoaneurysm
• Trauma

• infective endocarditis
• postoperative complications
• splenic rupture
• valvular endocarditis

• Chemotherapy
• Pancreatic cancer
• Splenic artery pseudoaneurysm

Splenomegaly/hypersplenism is one of the most common complications of portal hypertension. Splenic artery embolization (SAE) has been increasingly used for treatment of splenomegaly/hypersplenism. However, few studies focused on the severe complications after embolization. In this paper, we reported 16 cases of severe complications after SAE for portal hypertension.

From February 2011 to January 2019, 16 cirrhotic patients were diagnosed with severe complications after embolization. The clinical symptoms, therapies and prognosis were analyzed.

In these patients, the splenic embolization volume was between 50% and 70%. Among 16 cases, 7 patients were diagnosed with splenic abscess and/or left subphrenic abscess, suffered from the insistent fever, and eventually underwent the surgical therapy; 6 patients with left refractory pleural effusion, suffered from severe chest distress, and underwent repeated thoracocentesis or thoracic closed drainage; 3 patients with thrombosis in portal vein needed oral warfarin therapy.

In cirrhotic patients, the severe complications after SAE are not uncommon after the procedure. It causes more suffering, prolonged hospital stay and more medical cost in these patients. It was debatable whether this technique was an appropriate technique for portal hypertension due to liver cirrhosis, patients contraindicated for the treatment should be carefully identified to avoid the complications.

• complication
• hypersplenism
• portal hypertension
• splenic artery embolization

Visceral aneurysms are rare and a life threatening condition in the case of rupture.

A 78 year old woman presented with sudden brief loss of consciousness and complained of abdominal tenderness on examination. Computed tomography revealed a gigantic 100 × 130 × 200 mm ruptured true aneurysm of the gastroduodenal artery, which was successfully treated by endovascular coiling. Post-operative observation was uneventful and the six week follow up duplex ultrasound confirmed absence of luminal flow in the aneurysm.

The treatment threshold of visceral aneurysms and treatment modalities are reviewed.

•

Giant ruptured visceral aneurysm successfully treated endovascularly.

• Embolisation
• Gastroduodenal
• Rupture
• Treatment
• Visceral aneurysm

This study was performed to analyze the long-term follow-up safety and efficacy of transcatheter dense coil embolization for splenic artery aneurysms.

Thirty-two patients (18 women, 14 men; age range, 23–56 years; mean age, 43.1 ± 13.6 years) who underwent dense coil embolization for treatment of splenic artery aneurysms from August 2010 to January 2018 were retrospectively reviewed. The size and location of the splenic artery aneurysms, the technical and clinical outcomes of the procedure, and the complications related to the procedure were reviewed.

The technical success rate of embolization was 100% (mean aneurysm size, 29.4 ± 6.9 mm; range, 20–43 mm). Two (6.3%) patients underwent a successful repeat intervention procedure for recurrent aneurysm perfusion during follow-up (mean, 36 months; range, 6–72 months). No aneurysm ruptured during follow-up. Splenic infarction was observed in 8 of 32 (25%) patients. No patients developed major adverse events related to the procedure, such as splenic abscess or pancreatitis.

Percutaneous elective transcatheter dense coil embolization is safe and effective to prevent aneurysm rupture and overcome aneurysm recanalization during long-term follow-up.

• Transcatheter
• coil embolization
• efficacy
• long-term follow-up
• safety
• splenic artery aneurysms

Large upper gastro intestinal (GI) bleeding can be life-threatening. Splenic artery pseudoaenurysm (SAP) is rare but can cause massive upper GI bleeding. We report a case of a 57-year-old woman who had massive upper GI bleeding from SAP eroding into distal duodenum. Literature review shows SAP can bleed into stomach or pancreatic pseudocyst or biliary tree and peritoneal cavity; however, there are no previous reported cases of SAP bleeding into distal duodenum. Splenic artery embolization (SAE) is the preferred treatment for a bleeding SAP. Splenic infarcts can result following a SAE.

The spleen is the most commonly injured organ in blunt abdominal trauma. Unstable patients undergo laparotomy and splenectomy. Stable patients with lower grade injuries are treated conservatively; those stable patients with moderate to severe splenic injuries (grade III-V) benefit from endovascular splenic artery embolization. Two widely used embolization approaches are proximal and distal splenic artery embolization. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained via collateral pathways. Distal embolization can be used in cases of focal injury. In this article we review relevant literature on splenic embolization indication, and technique, comparing and contrasting proximal and distal embolization. Additionally, we review relevant anatomy and discuss collateral perfusion pathways following proximal embolization. Finally, we review potential complications of splenic artery embolization.

• Blunt abdominal trauma
• Proximal splenic embolization
• Splenic anatomy
• Splenic embolization
• Splenic salvage

• aneurysm
• endovascular embolization
• splenic artery

• Arterial bleeding
• Cyanoacrylate glue
• Embolization
• Gastrointestinal bleeding
• Outcomes
• Rectus sheath hematoma

Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment.

To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality.

A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization.

The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01).

In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

• gastrointestinal
• hemorrhage
• transcatheter arterial embolization

• aneurysm
• contrast-enhanced sonography
• endoleak
• endovascular
• stent
• vascular ultrasound
• visceral artery

• Aged, 80 and over
• Aneurysm/diagnosis
• Aneurysm/surgery
• Celiac Artery/diagnostic imaging
• Celiac Artery/surgery
• Contrast Media
• Hepatic Artery/diagnostic imaging
• Hepatic Artery/surgery
• Humans
• Image Enhancement/methods
• Male
• Stents
• Treatment Outcome
• Ultrasonography/methods

• Splenic artery
• aneurysm
• aneurysm/therapy
• pseudoaneurysm
• surgery

• Aneurysm
• Embolization
• Management
• Splanchnic artery

• Aneurysm
• Angiography
• Embolization
• False aneurysm
• Stent-graft
• Visceral artery

• Splenic artery pseudoaneurysm

• Aneurysm, False/diagnosis
• Aneurysm, False/surgery
• Cholangiopancreatography, Magnetic Resonance
• Diagnosis, Differential
• Endoscopy, Digestive System
• Humans
• Male
• Pancreatic Cyst/diagnosis
• Splenic Artery
• Tomography, X-Ray Computed
• Young Adult

• Enbucrilate
• False aneurysm
• Hemorrhage
• Interventional radiology
• Therapeutic embolization