From a right femoral access, we catheterized the splenic artery to perform diagnostic angiography using a 5f. Embolization for splenic trauma endovascular today. Majercik, md, jeff jednacz, md, robert lambiase, md, and william g. Distal embolization can be used in cases of focal injury.
In patients with hilar aneurysms, such as the one presented, coil embolization is a viable option. To elucidate the role of partial splenic embolization pse procedures, longterm outcome was assessed in terms of the recurrence of thrombocytopenia. Concejero,2 chaolong chen,2 and yufan cheng1 splenic vein thrombosis with gastric variceal bleeding is. Splenic artery aneurysms saa are the most frequent visceral artery aneurysms. Spleen artery aneurysm an overview sciencedirect topics. Management of splenic injury depends on the clinical status of the patient and can include nonoperative management nom.
Pdf the use of splenic artery embolization to maintain. Background splenic artery aneurysms saa are the most frequent visceral artery aneurysms. Large and symptomaticaneurysms have an increased risk for rupture and should be treated interventionally or surgically. Partial splenic artery embolization in the treatment of.
Large and symptomatic aneurysms have an increased risk for rupture and should be treated interventionally or surgically. With the help of splenic artery embolization, success rates of more than 80% have also been described for highgrade splenic injuries. The favourable outcome of our patient depicts a pivotal role of preoperative splenic artery embolization in haemodynamically compromised patients undergoing cardiac valvular surgery for ie. If you are looking for a way to combine two or more pdfs into a single file, try pdfchef for free. We read with interest the article entitled contrast. Partial splenic artery embolization endovascular today. Splenic embolization for portal hypertension full text view. Partial splenic embolization versus splenectomy for the. In nonoperatively managed cases, sae is sometimes used to control. Splenic artery embolization sae, in a patient with. This technique can be used safely when total embolization. Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients. Splenic artery aneurysm is the third most common abdominal aneurysm following abdominal aortic aneurysm and iliac artery aneurysm.
Kamimura k, abe h, suda t, aoyagi y, liu d 20 efficacy and safety of partial splenic artery embolization in patients with decompensated cirrhosis awaiting liver transplantation. Embolization of a large, symptomatic splenic artery. Predictors of splenic artery embolization as an adjunct to. Splenic artery embolization sae is one method to achieve decreased portal vein pv perfusion. Severe complications after splenic artery embolization for. This free online tool allows to combine multiple pdf or image files into a single pdf document. Splenic artery embolization, first performed by maddison 6, has been used in patients with hypersplenism, hematologic disorders, and splenic trauma.
A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Splenic artery embolization as an adjunctive procedure for. Splenic artery embolization for treatment of refractory. 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.
The overall mortality was 10% while 77% had complete recovery. Splenic embolization for a giant splenic hemangioma in a. The spleen is the second most commonly injured organ in cases of abdominal trauma. Proximal splenic artery embolization achieves hemostasis by reducing arterial pulse pressure and decreasing distal arterial flow in splenic parenchyma, which is beneficial for peripheral clot formation rather than stopping parenchymal hemorrhage directly. Liver transplantation and splenic artery steal syndrome. Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Case report splenic artery embolization for the treatment of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis. The splenic artery appeared very delicate and reacted with intense vasospasm following minimal movement of the endovascular catheter tip. Majority of the patients with splenic rupture were managed with splenectomy while the rest were managed conservatively p 0. The primary purpose of this study is to evaluate the safety and efficacy of partial splenic artery embolization in the treatment of symptomatic portal vein hypertension. However, its clinical usefulness has been reduced because of its complications such as splenic abscess formation, splenic rupture, and septicemia encountered after embolization with gelfoam cubes7. Splenic haematoma complicating infective endocarditis. Boston scientific, fremont, ca, usa particles were initially used for splenic artery embolization.
In addition, major requiring splenectomy or minor not requiring splenectomy rebleeding, infarction, and infection in relation to the site of. The evaluation of splenomegaly in children and considerations related to elective or traumatic splenectomy are discussed separately. The goal of nom is to minimize the need for laparotomy and maximise the rate of splenic preservation. Review article clinical application of partial splenic embolization yongsongguan 1,2 andyinghu 1,2 department of oncology, west china hospital, sichuan university, chengdu, china state key laboratory of biotherapy, sichuan university, chengdu, china correspondence should be addressed to yongsong guan.
Two widely used embolization approaches are proximal and distal splenic artery embolization. Complications arising from splenic embolization after blunt. A splenic artery embolization can be performed before the surgery, in order to decrease both the size of the spleen and the risk of bleeding. Successful embolisation of a life threatening bleeding. Background splenic artery embolization sae has gained increasing acceptance as an important adjunct in the treatment of splenic injuries. Severe complications after splenic artery embolization for portal hypertension due to hepatic cirrhosis. The occlusion of the main artery lowers distal systolic arterial pressure by 40 mm hg on average, enhancing the. For this purpose, a microcatheter is necessary, supported by a flexible and hydrophilic 4f catheter. Review article clinical application of partial splenic. Splenic artery embolization sae, in a patient with consumptive coagulopathy due to massive colonic bleeding, and massive blood transfusion, as a bridging therapy before colonic surgery.
Angiographic embolization of a posttraumatic splenic. Hepatic arterial embolization in patients with neuroendocrine. Aneurysms of the splenic artery in liver transplant. Rebleeding of a splenic artery aneurysm after coil embolisation.
Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks. Evaluation of three methods of treatment of hypersplenism. For proximal coil embolizations, the spleen did not decrease significantly in size. We present a case of acute necrotizing pancreatitis after splenicartery embolization for acute splenic injury. Partial splenic artery embolization pse has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. Embolization of a giant splenic artery aneurysm insight. Presence and extension of liver metastases are considered important prognostic factors, as they may significantly impair the patients quality of life, because of either tumor bulk or hormonal hypersecretion. When embolization is planned, visualization of the pancreatic arteries is essential to reduce the risk of their unintended embolization. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained. Therapies for nen liver metastases include surgical resection, liver transplantation, chemotherapy and. We occluded the splenic artery at the distal level. The embolization of intraparenchymal arterial bleeding needs to reach small peripheral arteries. Jun 10, 2009 hypersplenism occurs in patients with chronic liver disease, and splenectomy is the definitive treatment.
Advantages of single port surgery are mostly cosmetic. Recognize the signs and symptoms of splenic injuries describe the important principles for successful resuscitation and. The main splenic artery is then catheterized and a splenic arteriogram performed. In conclusion, based on pre and postembolization ct, coil embolization of the splenic artery resulted in a significant decrease in splenic volume only when performed distally, although the degree of volume loss was generally modest. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm group i, except the first two 1820. Examine the usefulness of splenic artery embolization and compare it with surgery for patients with actively bleeding spleen injuries. Enhanced ultrasound diagnosis of splenic artery steal syndrome after orthotopic liver transplantation by zhu et al.
Transcatheter embolization of a splenic artery aneurysm. 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. Emergency splenic arterial embolization for massive. A comparative study of surgical splenectomy, partial. Splenic artery embolization before laparoscopic splenectomy. Emergency splenic arterial embolization for massive variceal bleeding in liver recipient with leftsided portal hypertension hsinyou ou,1 tungliang huang,1 taiyi chen,1 leo leungchit tsang,1 allan m. Splenic artery embolization is used after splenic trauma topreserve the splenic parenchyma but its efficacy is unproven. 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. If the splenic artery is long and winding, a triple coaxial catheterization may be required. Methods this was a multiinstitutional retrospective study of all adults. Splenic artery aneurysms are the most common visceral artery aneurysms, with a reported prevalence of 0. Nom may comprise of observation alone or splenic artery embolization sae. We therefore sought to determine whether selective splenic artery embolization ssae is a safe and effective alternative to splenectomy for. 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.
A 28 year old female presented 9 weeks after the term delivery of a healthy baby with severe abdominal pain, shortness of breath and headaches. Granger, md trauma surgeon, intermountain medical center, intermountain healthcare. Methods we describe the case of a 44yearold male patient with a possibly mycotic splenic artery aneurysm of approximately 12 cm in diameter. A significant reduction in splenectomy rate was also observed 20% to 14. Aichi, japan was inserted through the angiographic catheter and advanced through the distal splenic artery at the level of the hilum. Following embolization, angiography demonstrated complete occlusion of the splenic artery fig.
We then decided to go distally to the peripheral intrasplenic branches to perform a more selective embolization. Splenic artery embolization for massive splenomegaly. If a distal embolization procedure is to be performed, a microcatheter and wire combination e. May 19, 2014 liver metastases occur in 4693% of patients with neuroendocrine neoplasms nens. Over the past decade, angiography with transcatheter splenic artery embolization, an alternative nonoperative treatment for splenic injuries, has increased splenic salvage rates to as high as 97%. Splenic artery aneurysms are rare, but still the third most common abdominal aneurysm, after aneurysms of the abdominal aorta and iliac arteries. Flush arteriography via the common femoral artery confirmed the presence of a pseudoaneurysm at an intrasplenic ascending branch of the splenic artery. Spleen artery embolization aggravates endotoxin hyporesponse of peripheral blood mononuclear cells in patients with spleen injury. Boston scientific, natick, ma are placed as distally and near to the injured vessel as possible. Splenic artery embolization for the treatment of refractory. For gelatin sponge embolization, when the splenic artery could be catheterized with a 4 or 5french catheter, gelatin sponge torpedoes were injected in rapid succession from a proximal. Antibody response to a tcellindependent antigen is preserved after splenic artery embolization for trauma.
Microcatheters were introduced and distal selective embolization of the pseudoaneurysm was performed using coils. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained via collateral pathways. However, the indications for sae have not been clearly defined and, in some cases, the potential complications of the procedure. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Pdfdateien in einzelne seiten aufteilen, seiten loschen oder drehen, pdfdateien einfach zusammenfugen oder.
Following introduction of regional trauma networks, the use of splenic artery embolization for management of blunt splenic injury increased from 3. Is there an immunologic deficiency after splenic embolization. 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. Advances in catheterization techniques have led to the broadening of the indications of splenic artery embolization. Splenic trauma background the spleen is the solid organ most frequently injured in blunt abdominal trauma. With the first approach, selective partial embolization, a few distal branches of the splenic artery are selectively catheterized, and embolization is performed to achieve complete stasis in these branches while several other branches are left untreated, figs 6, 7. Selective splenic artery embolization for the treatment of. Splenic artery embolization in blunt trauma vascular and interventional radiology original research. The splenic artery has many branches that supply the pancreatic body and tail. Paired with careful planning, this alternative procedure is a viable consideration for hypersplenism and portal hypertension complications. Recently, splenic artery embolization sae has been described as an effective procedure for reducing portal hyperperfusion in patients undergoing partial or whole liver transplantation. The management for subcapsular splenic hematoma remains controversial.
Splenic artery embolization with gelatin sponge appears to be as effec tive and as safe as coil embolization and can be completed in a shorter time. Background we sought to identify predictors of splenic artery embolization sae over observation for hemodynamically stable patients with blunt splenic injury bsi, by organ injury scale ois grade. Embolization of the entire splenic artery, if selective catheterization of the aneurysm cannot be performed, is an alternative option. Strategies for endovascular treatment of complicated. Risk factors for rupture include portal hypertension and pregnancy. Few patients 6% were managed with proximal splenic artery splenic embolization and 4% were managed with laparoscopic repair. Fear of arterial dissection together with the tortuous aspect of the distal splenic artery urged the interventionalist to refrain from coil embolisation at the distal end of the aneurysm. The methods of treatment for this condition include surgical resection, minimally invasive techniques include laparoscopic technique and endovascular therapy.
Efficacy and safety of partial splenic artery embolization in. We describe the case of a 44yearold male patientwith a possibly. Splenic artery angioembolization embo has been promoted to increase the success rate of nonoperative management of splenic injuries. Sae for hepatic artery resistance and portal hyperperfusion n42 or asciteshydrothorax n12 hepatic artery buffer response portal vein flow flow spleenliver ratio postsae pv sae control. They may occur in pregnant women in the third trimester and rupture carries a maternal mortality of greater than 50% and a fetal mortality of 7090%. Subcapsular splenic hematoma is a rare complication of pancreatitis. However, the operation may be hazardous in patients with poor liver function. A secondary aim is to evaluate the relative efficacy of two separate splenic artery embolization techniques, coiling versus particle embolization of the spleen.
Acute necrotizing pancreatitis following splenic artery. Splenic artery aneurysms occur infrequently in the normal population, but presents with increased incidence among cirrhotic patients with portal hypertension. Immunization record for adults with a splenectomy or. This study was conducted to assess the safety and efficacy of pse compared to splenectomy in.
Thus, the risks and potential benefits of splenic artery embolization sae were explained to the patient and her husband, and informed consent was obtained for the procedure. Embolization of more than 70% of splenic parenchyma is generally not recommended. Splenic artery aneurysms away from the hilum can be excluded with a stent graft. Methods did not explicitly this was a multiinstitutional retrospective study of all adults. While partial splenic artery embolization 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. Efficacy and surgical procedures of preoperative splenic. Braun, sempach, switzerland was additionally used for more complete embolization. The use of splenic artery embolization to maintain adequate hepatic arterial inflow after hepatic artery thrombosis in a split liver transplant recipient. For highgrade trauma grades 35 on the american association for the surgery of trauma classification scale without bleeding lesions, haan et al 1 and gaarder et al 2 have demonstrated that proximal occlusion of the splenic artery decreases the risk of splenectomy by 16% to 18%. Splenomegaly in children see approach to the child with an enlarged spleen.
Here, we report the case of a 56yearold man diagnosed with massive splenomegaly, secondary to a marginal splenic lymphoma, which had a. Most are small less than 2 cm, saccular aneurysms, and more than 80% are located in the mid or distal splenic artery. Residual immunologic function of the spleen after embolization and its consequences on early infectious complications still remain intensely debated. Splenic artery embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. Nonoperative management nom of blunt splenic injuries in adult trauma patients is an accepted treatment protocol having evolved from its successful use in children. Under strict aseptic conditions, a percutaneous femoral artery approach was used for superselective catheterization of the splenic artery under local anesthesia xylocaine 2% by the seldinger method 18. This simple webbased tool lets you merge pdf files in batches. Volumetric computed tomography before embolization indicated that the spleen was 1896 g. These aneurysms are 4 times more common in women than in men. Role of splenic artery partial embolization in a patient with. In recent years, partial splenic embolization pse has been widely used in patients with hypersplenism and cirrhosis. The optimal management of splenic artery aneurysms and the prevention of spontaneous rupture in these patients present a therapeutic challenge for transplant physicians and surgeons. Irrespective of proximal or distal embolization technique, splenic artery embolization is effective for both hemorrhage control and preservation of splenic function. Splenectomy could alleviate thrombocytopenia and reduce portal pressure, but it can cause postoperative thromboses and opportunistic infections.
We herein report a case of a large subcapsular splenic hematoma with a large pancreatic pseudocyst, which was successfully treated with splenic arterial embolization and ultrasound us guided percutaneous drainage of pancreatic pseudocyst, for the first. Complications arising from splenic embolization after blunt splenic trauma article in the american journal of surgery 1893. It is estimated that 6% to 10% of splenic artery aneurysms will rupture, and 25% to 40% of those ruptures will occur during pregnancy, especially during the third trimester. Preoperative splenic artery embolization was successfully performed and the patient subsequently received lifesaving cardiac valvular replacement surgery. Splenic artery aneurysms are multiple in 20% of cases. Aneurysms of an aberrant splenic artery originating from the superior mesenteric artery sma are extremely rare. In severe cases, transjugular intrahepatic portosystemic shunts, portocaval shunts, and liver retransplantation have been used with marginal results. Review of proximal splenic artery embolization in blunt. 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.
Went did several,angiograms,via cannulation,of right common femoral artery,cannulation,of the aorta, via the iliac system. This study assessed preoperative splenic artery embolization before laparoscopic splenectomy. Preoperative splenic artery embolization was used in 26 of 54 patients 48% undergoing laparoscopic splenectomy. In nonoperatively managed cases, sae is sometimes used to control haemorrhage. The success of the procedure is based on coordination between the trauma surgeon and the interventional radiologist for the correct selection of patients. Splenic embolization procedure answers on healthtap. Partial splenic artery embolization in cirrhotic patients. Single port surgery uses a special port that multiple instruments go through, unlike traditional laparoscopy where each port canfield only one instrument. Imaging and transcatheter arterial embolization for. Parenchymal phase angiograms may be used to estimate the volume of the. Splenic embolization for portal hypertension full text. Case report splenic artery embolization for the treatment of. Sara abel jalil, jaber tawil, laui shaheen, tawfeeq abu eisheh, samir issa hasan and yasser abu safieh. Case report we report of a 49yearold white man with a medical history significant for diabetes mellitus and endstage liver disease due to chronic hepatitis c and alcoholrelated cirrhosis.
Successful treatment of aberrant splenic artery aneurysm. Although their indications are yet to be completely established in hematology, splenic embolizations are valuable as a programmed procedure in treating vulnerable patients affected by pseudoaneurysms, aneurysms, hypersplenism, as well as splenic traumas in an emergency. A decision wasmade at that time to proceed with embolization hoping to avoidsurgical intervention. How to code for a percutaneous splenic artery embolization. Splenic artery aneurysms are the most common visceral artery aneurysms. In the past 3 decades, the treatment of traumatic splenic inju. It is four times more frequent in women, but men are three times more likely to have a rupture 2. Splenic embolization is a technique that can be used alone or in conjunction with other treatments for the mitigation of portal hypertension and associated physiological effects of portal hypertension. This topic provides an overview of normal splenic size and function and an approach to evaluating splenic abnormalities in adults. Embolization of a giant splenic artery aneurysm abstract background.
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