Blunt Splenic Injury: Efficacy of Superselective Splenic Artery Embolization

Authors

  • CP Chou Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, 01655 USA
  • YH Kim Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, 01655
  • S Tresoldi Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, 01655 USA; Diagnostic and Interventional Radiology Department, A.O. San Paolo Via A. di Rudini 8, 20142 Milan, Italy
  • EI Tikh Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, 01655
  • S Baker Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01655
  • K Kandarpa Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, 01655
  • D Kim Department of Radiology, Boston Medical Center, Boston University, Boston, MA 02118

DOI:

https://doi.org/10.3126/njr.v3i2.9606

Keywords:

Embolization, Nonsurgical management, Splenic angiography, Splenic injury, Splenic laceration

Abstract

Objective: To evaluate the efficacy of superselective splenic artery embolization (SAE) using a coaxial catheter technique in patients with blunt splenic injury.

Patient Selection and Methods: We retrospectively reviewed cases of 24 consecutive patients undergoing splenic angiography for blunt splenic injury at a Level 1 trauma center. After angiographic confirmation of splenic injury, superselective SAE was performed using gelfoam pledgets (n=15), with or without coils, and liquid embolic materials (n=9). All procedures were performed through a microcatheter advanced coaxially through a selective angiographic catheter. Severity of splenic injury was graded using CT imaging. The angiographic findings were retrospectively divided into four groups. Outcome measures included technical success, complications and recurrence of symptoms requiring additional intervention or surgery despite embolization.

Results: All cases were technically successful, with immediate occlusion of targeted vessels after embolization. One patient underwent distal pancreatectomy- splenectomy 3 days after splenic embolization due to symptoms related to distal pancreatic injury, unrelated to the angiographic intervention. A second embolization was performed 1-3 days after initial embolization in 4 patients with clinical suspicion of re-bleeding. One of these four patients underwent splenectomy 3 days after the second embolization, during exploration for associated bowel and diaphragmatic injury. A second patient underwent splenectomy 1 day after a second embolization due to need for continued transfusions. The splenic salvage rate was not significantly related to CT grade of splenic injury (p=1.0) or angiographic classification (p=0.8).

Conclusion: Superselective SAE can be performed as a safe alternative to splenectomy in patients with blunt splenic trauma, particularly when there is no additional major organ injury.

DOI: http://dx.doi.org/10.3126/njr.v3i2.9606

Nepalese Journal of Radiology Vol.3(2)July-Dec, 2013: 37-48

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Published

2014-01-15

How to Cite

Chou, C., Kim, Y., Tresoldi, S., Tikh, E., Baker, S., Kandarpa, K., & Kim, D. (2014). Blunt Splenic Injury: Efficacy of Superselective Splenic Artery Embolization. Nepalese Journal of Radiology, 3(2), 37–48. https://doi.org/10.3126/njr.v3i2.9606

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Section

Original Articles