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