Review of proximal splenic artery embolization in blunt abdominal trauma

Keith Bertram Quencer,Tyler Andrew Smith

doi:10.1186/s42155-019-0055-3

Keith Bertram Quencer, Tyler Andrew Smith

Open Access

https://doi.org/10.1186/s42155-019-0055-3

Copy DOI

Journal: CVIR Endovascular	Publication Date: Mar 18, 2019
Citations: 47	License type: open-access

Affiliation: University of Utah

Abstract

The spleen is the most commonly injured organ in blunt abdominal trauma. Unstable patients undergo laparotomy and splenectomy. Stable patients with lower grade injuries are treated conservatively; those stable patients with moderate to severe splenic injuries (grade III-V) benefit from endovascular splenic artery embolization. Two widely used embolization approaches are proximal and distal splenic artery embolization. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained via collateral pathways. Distal embolization can be used in cases of focal injury. In this article we review relevant literature on splenic embolization indication, and technique, comparing and contrasting proximal and distal embolization. Additionally, we review relevant anatomy and discuss collateral perfusion pathways following proximal embolization. Finally, we review potential complications of splenic artery embolization.

Highlights

The spleen has many important roles including T-cell proliferation and antibody production and phagocytosis of senescent red blood cells (Coccolini et al 2017; Mebius and Kraal 2005)
American Association for the Surgery of Trauma (AAST) splenic laceration grade is based on computed tomography (CT) angiography findings (Moore et al 1994)
Two patients with delayed presentation of splenic artery pseudoaneurysm following blunt abdominal trauma. Both vascular injuries were diagnosed on a follow up CT scan, highlighting the need for follow up imaging in patients with blunt abdominal trauma

Summary

Introduction

The spleen has many important roles including T-cell proliferation and antibody production and phagocytosis of senescent red blood cells (Coccolini et al 2017; Mebius and Kraal 2005). In the setting of splenic trauma, splenectomy is avoided when possible. Avoiding splenectomy precludes the development of overwhelming post-splenectomy sepsis, a potentially fatal infection caused by encapsulated bacteria (Coccolini et al 2017; Uranus and Pfeifer 2001; Lynch and Kapila 1996; Cullingford et al 1991; Banerjee et al 2013). Trauma protocols are resource and institution dependent. Hemodynamically stable with significant blunt abdominal trauma are imaged with contrast enhanced computed tomography (CT). American Association for the Surgery of Trauma (AAST) splenic laceration grade is based on CT angiography findings (Moore et al 1994) (see Table 1)

Methods

Results

Conclusion