Trauma center variation in splenic artery embolization and. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained via collateral pathways. Here we describe our experience with sae for the treatment of ra. Surgery of trauma aast grades iii to v splenic injuries and those demonstrated to have vascular injuries. Splenic artery aneurysms saas constitute the highest percentage of vaas at 60%, renal artery aneurysms raas are the second common type of vaa, and hepatic artery aneurysms haas are the most symptomatic. Splenic artery embolization for nonsurgical splenectomy. Splenic artery embolization diagnostic and interventional radiology.
If a distal embolization procedure is to be performed, a microcatheter and wire combination e. Embolization treatment for splenic artery aneurysms. Following embolization, angiography demonstrated complete occlusion of the splenic artery fig. For procedure planning, celiac and splenic artery anatomy should be evaluated on contrastenhanced ct images, including two and threedimensional formats, to help determine a vascular access route and choose adequate materials for either proximal or distal splenic artery embolization. Majercik, md, jeff jednacz, md, robert lambiase, md, and william g. Background the spleen is the second most commonly injured organ in cases of abdominal trauma. Splenic artery embolization could be the best treatment option for gastric variceal bleeding when splenectomy is difficult such as in case associated with.
The splenic artery or lienal artery is the blood vessel that supplies oxygenated blood to the spleen. Splenic embolization for a giant splenic hemangioma in a. Splenic artery syndrome is a poorly understood phenomenon with no current consensus on clinical diagnosis criteria. Selective splenic artery embolization for the treatment of.
The most frequent complication observed was splenic infarction, being. Splenic artery definition of splenic artery by the free. Pdf utility of the amplatzer vascular plug in splenic. Most are small less than 2 cm, saccular aneurysms, and more than 80% are located in the mid or distal splenic artery. The patients did not receive total but only partial embolization of splenic artery, with the splenic embolization volume ranging from 50% to 70%. Boston scientific, natick, ma are placed as distally and near to the injured vessel as possible.
Splenic artery aneurysms are the most common visceral artery aneurysms. Splenic artery embolization has been used as an adjunct to nonsurgical treatment of blunt splenic injuries. Splenic artery embolization as an adjunctive procedure for portal. Embolization that occurred distal to the main splenic artery trunk was considered to be distal. Embolization for splenic trauma endovascular today. Splenic embolization in hypersplenic thrombocytopenia. Pdf splenic artery embolization for massive splenomegaly. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained.
Embolization of a giant splenic artery aneurysm insight. Splenic artery embolization for the treatment of refractory. An alternative approach in a critically ill patient with autoimmune hemolytic anemia. It branches from the celiac artery, and follows a course superior to the pancreas. Nov 17, 2016 splenic artery embolization is a safe and effective alternative to surgical splenectomy, especially in patients who are poor surgical candidates due to associated comorbidities. The increased susceptibility of patients to infections after splenectomy has led to the use of splenic preservation procedures 4, 5. A clinical study was performed, with splenic function assessed by examining the antibody response to polysaccharide antigens pneumococcal 23valent. Nonoperative management was carried out successfully in 22% of patients who sustained a spleen injury after colonoscopy. Third, the risk of parenchymal bleeding during surgical dissection may be increased due to the size of the spleen and intrasplenic vascular malformation involvement. Embolization to occlude ruptured peripheral aneurysms with hemorrhage superior mesenteric artery inferior mesenteric artery gastroduodenal artery splenic artery renal artery hepatic artery internal iliac hypogastric artery embolization to occlude vessels with hemorrhage due to trauma or vessel injury. Distal embolization can be used in cases of focal injury. Transcatheter embolization of a splenic artery aneurysm. If the celiac trunk is horizontal and the splenic artery is reasonably straight, it can be easily occluded with a type ii or iv vascular plug. However, if the celiac trunk is horizontal and the splenic artery is tortuous, reaching the middle part of the splenic artery with a sheath or a guiding catheter may be difficult.
Mar 27, 2014 splenectomy could alleviate thrombocytopenia and reduce portal pressure, but it can cause postoperative thromboses and opportunistic infections. Proximal splenic artery embolization in children may be a safe therapeutic alternative to either conservative or surgical management in spontaneous splenic rupture. Splenic artery embolization for the treatment of gastric. Transcatheter splenic artery embolization has a major role in the management of traumatic splenic injuries and as an adjunctive procedure in the treatment of thrombocytopenia and portal hypertension. Proximal sae was defined as the embolization of the main trunk of the splenic artery in a proximal location. Review of proximal splenic artery embolization in blunt. A significant reduction in splenectomy rate was also observed 20% to 14. Preoperative splenic artery embolization in klippel. Preservation of splenic tissue with a reduced risk of repeated hemorrhage can be obtained with proximal splenic artery embolization. Pdf on jan 27, 2017, marcello di martino and others published splenic artery embolization for massive splenomegaly find, read and cite all the research. Splenic artery embolization, which potentially preserves splenic function, was reported in a few cases. Transcatheter coil embolization of splenic artery aneurysm. Preoperative splenic artery embolization was used in 26 of 54 patients 48% undergoing laparoscopic splenectomy.
The main splenic artery is then catheterized and a splenic arteriogram performed. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for. Herein, we report a case of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis successfully treated with splenic artery embolization. Splenic artery embolization sae is increasingly being used as a nonoperative management strategy for patients with blunt splenic injury following trauma. Salient points for each vaa are summarized in table 1410 and case examples are shown in figures 1 and 2. Case report splenic artery embolization for the treatment of. Splenic artery embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. Chung and reuter 2 embolized the splenic artery in dogs and found the spleen to be shrunken and fibrosed at 8 weeks. In patients with hilar aneurysms, such as the one presented, coil embolization is a viable option.
Most aneurysms are small splenic artery steal syndrome with the advantage of radiologic intervention to embolize the splenic artery and improve the hepatic arterial inflow. Mar 18, 2019 two widely used embolization approaches are proximal and distal splenic artery embolization. Recently, splenic artery embolization sae has been described as an effective procedure for reducing portal hyperperfusion in patients undergoing partial or whole liver transplantation. Since the introduction of major trauma centres and regional trauma networks in 2012, management of splenic injury has shifted, with nonoperative management now favoured. This study was performed to investigate the efficacy of proximal splenic artery embolization using detachable balloons for patients with hypersplenism and portal hypertension. The aim of this study was to assess the splenic function of patients who were embolized. Embolization of the entire splenic artery, if selective catheterization of the aneurysm cannot be performed, is an alternative option. Completion arteriography was performed from the proximal main splenic artery to ensure cessation of flow and absence of additional injury. The clinical data of the patients are shown in table 1. It was first described in 1981 by sclafani 3 and became more widely used in the late 1990s. Utility of the amplatzer vascular plug in splenic artery embolization.
All these patients underwent sae in other hospitals. Emoliation endovascular management of visceral artery. In this patient population, partial splenic embolization can decrease the incidence of variceal bleeding, and protection can persist for at least a year. Proximal splenic artery embolization blocks the splenic artery inflow to the spleen, thus, decreases the risk of intraoperative arterial bleeding. A comparison study with conventional coil technique. When the splenic artery could not be catheterized with the 4 or 5french catheters owing to vessel tortuosity or stenosis at the origin of the celiac artery, or if distal embolization was intended, a 2 to 2.
In prior decades, splenic arterial embolization sae was used increasingly in the setting of nonoperative management of blunt splenic trauma. Cureus grade iii spleen laceration after a colonoscopy. Splenic artery embolization before laparoscopic splenectomy. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm group i, except the first two 1820.
For those requiring intervention, splenic artery embolisation is well established as a firstline treatment in all but the most severely injured. Management of splenic injury depends on the clinical status of the patient and can include nonoperative management nom, splenic artery embolization sae, surgery operative splenic salvage or splenectomy, or a combination of these treatments. Splenic trauma can also be treated by embolization of the splenic artery. We analyzed their clinical symptoms, treatments and prognoses. Splenic artery angioembolization embo has been promoted to increase the success rate of nonoperative management of splenic injuries. It is an especially useful for the treatment of variceal bleeding due to hepatic cirrhosis. Two widely used embolization approaches are proximal and distal splenic artery embolization. Splenic artery aneurysms are the most common visceral artery aneurysms, with a reported prevalence of 0.
We therefore sought to determine whether selective splenic artery embolization ssae is a safe and effective alternative to splenectomy for tst in patients with pnh. Background splenic artery embolization sae has been an effective adjunct to the nonoperative management nom for blunt splenic injury bsi. Braun, sempach, switzerland was additionally used for more complete embolization. Maddison 3 reported a successful medical splenectomy in a patient who underwent selective splenic arterial embolization. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Necrosis of the tail of pancreas following proximal splenic. These aneurysms are 4 times more common in women than in men. Proximal splenic artery embolization in the management of sp. Following introduction of regional trauma networks, the use of splenic artery embolization for management of blunt splenic injury increased from 3. The splenic artery gives off branches to the stomach and pancreas before reaching the spleen. Splenic artery aneurysms are the most common visceral artery aneurysms and account for up to 60% of all visceral artery aneurysms. Complications arising from splenic artery embolization.
While splenic artery embolization is increasing in frequency, more investigators have reported complications associated with embolization techniques. Splenic arterial interventions rsna publications online. Antibody response to a tcellindependent antigen is. The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Review of proximal splenic artery embolization in blunt abdominal. Splenic artery aneurysms away from the hilum can be excluded with a stent graft. Severe complications after splenic artery embolization for. Splenic artery embolization sae is an accepted nonsurgical inter vention for the treatment of a variety of clinical disorders 1.
The splenic artery has many branches that supply the pancreatic body and tail. In hemodynamically unstable patients, splenectomy is the definitive management. Use of splenic artery embolization as an adjunct to nonsurgical. Splenic artery embolization sharabanode 49 international ournal of recent surgical and medical sciences v ol. Pdf splenic liquefaction after splenic artery embolization.
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