Distal embolization versus combined embolization techniques for blunt splenic injuries: comparison of the efficacy and complications.

Yon-Cheong Wong,Huan-Wu Chen,Cheng-Hsien Wu,Li-Jen Wang,Shih-Ching Kang,Yu-Pao Hsu,Kuo-Ching Yuan,Being-Chuan Lin

doi:10.18632/oncotarget.21527

Yon-Cheong Wong, Huan-Wu Chen + Show 6 more

Open Access

https://doi.org/10.18632/oncotarget.21527

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Journal: Oncotarget	Publication Date: Oct 5, 2017
Citations: 5	License type: cc-by

Affiliation: Chang Gung Memorial Hospital

Abstract

Comparable failure rates of distal or proximal transcatheter arterial embolization (TAE) techniques for blunt splenic injuries have been reported. This study is to investigate the efficacy and complication of combining both TAE techniques.We included 26 patients of blunt splenic injuries for TAE therapy and randomized them into distal TAE and combined TAE groups. A prospective study was performed to compare their demographics, clinical parameters, hemograms, post-TAE splenic infarct volumes, splenic abscess and pancreatitis between the two groups.Of 26 patients, 17 received distal TAE, 9 received combined TAE. Their basic demographics, clinical parameters and hemograms did not differ. Mean systolic blood pressure of all patients was significantly elevated after TAE at 24 hours later. Three patients of distal TAE group had residual pseudoaneurysms in follow up. They were considered failures in distal TAE group as opposed to all successes in combined TAE group. The risk difference of failure of distal TAE was 17.6%. None developed post-TAE splenic abscess, massive splenic infarct or pancreatitis. The mean splenic infarct volume of distal TAE (10.9%) versus combined TAE groups (6.6%) was not significant (p = 0.481).Combined TAE is effective and safe to decrease the failure rates of non-operative management for blunt splenic injuries.

Highlights

Non-operative management has become the standard of practice for blunt splenic injuries in hemodynamically stable patients [1,2,3,4]
This study is to investigate the efficacy and complication of combining both transcatheter arterial embolization (TAE) techniques
Within a two year study period, a total of 33 patients met the inclusion criteria. They were of blunt splenic injuries with CT findings of contrast medium extravasation and were hemodynamically stable for TAE treatment

Summary

Introduction

Non-operative management has become the standard of practice for blunt splenic injuries in hemodynamically stable patients [1,2,3,4]. Proximal TAE which is a technique of main splenic artery occlusion is adequate to stop splenic hemorrhage in most blunt splenic injuries [5, 10]. Persistent pseudoaneurysms or new pseudoaneurysms could occur in about 10% of major injuries despite an initially successful proximal TAE [14,15,16]. This failure of proximal TAE can be attributed to rich collateral arteries distal to the site of main splenic artery occlusion [5, 10, 14, 16]. Recent meta-analysis study has shown that failure rates in both techniques are comparable [5]

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