Proximal Embolization Research Articles

Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions-Erratum.

HomeRadioGraphicsVol. 37, No. 3 PreviousNext ErrataFree AccessDiagnosis and Management of Complications from Percutaneous Biliary Tract Interventions—ErratumNanda Venkatanarasimha, Karthik Damodharan, Apoorva Gogna, Sum Leong, Chow Wei Too, Ankur Patel, Kiang Hiong Tay, Bien Soo Tan, Richard Lo, Farah IraniNanda Venkatanarasimha, Karthik Damodharan, Apoorva Gogna, Sum Leong, Chow Wei Too, Ankur Patel, Kiang Hiong Tay, Bien Soo Tan, Richard Lo, Farah IraniNanda VenkatanarasimhaKarthik DamodharanApoorva GognaSum LeongChow Wei TooAnkur PatelKiang Hiong TayBien Soo TanRichard LoFarah IraniPublished Online:May 11 2017https://doi.org/10.1148/rg.2017174004MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Originally published in:RadioGraphics 2017;37(2):665–680 • DOI: 10.1148/rg.2017160159Diagnosis and Management of Complications from Percutaneous Biliary Tract InterventionsErratum in:RadioGraphics 2017;37(3):1004 • DOI: 10.1148/rg.2017174004Page 665, column 1, byline: The second author’s name should read as follows: “Karthikeyan Damodharan, MBBS, MRCP, FRCR.”Article HistoryPublished online: May 11 2017Published in print: May 2017 FiguresReferencesRelatedDetailsCited ByRelieving the bile ducts prior to pancreatoduodenectomy – A retrospective cohort studyWaqasFarooqui, LuitPenninga, Stefan KobbelgaardBurgdorf, Paul SunoKrohn, Jan HenrikStorkholm, Carsten PalnæsHansen2022 | Annals of Medicine and Surgery, Vol. 84Primary Clinical Application of Y-Shaped Jogged Stent Implantation in Patients with Malignant Hilar Biliary ObstructionZhongweiZhao, JingjingSong, XiaoxiFan, ShijiFang, MinjiangChen, WeiqianChen, FazongWu, LiyunZheng, JianfeiTu, JiansongJi2019 | Journal of Gastrointestinal Surgery, Vol. 23, No. 4Trans biliary proximal and distal coil embolization of an arteriobiliary fistula: report of a case and review of literatureFarisGalambo, MajidMaybody2019 | CVIR Endovascular, Vol. 2, No. 1Management of Biliary Strictures: State-of-the-Art ReviewBaljendra S. Kapoor, Giovanni Mauri, Jonathan M. Lorenz, 23 October 2018 | Radiology, Vol. 289, No. 3Accompanying This ArticleDiagnosis and Management of Complications from Percutaneous Biliary Tract InterventionsMar 13 2017RadioGraphicsRecommended Articles MR Cholangiopancreatography: What Every Radiology Resident Must KnowRadioGraphics2020Volume: 40Issue: 5pp. 1263-1264Imaging Features of Primary Sclerosing Cholangitis: From Diagnosis to Liver Transplant Follow-upRadioGraphics2019Volume: 39Issue: 7pp. 1938-1964Management of Biliary Strictures: State-of-the-Art ReviewRadiology2018Volume: 289Issue: 3pp. 590-603Diagnosis and Management of Complications from Percutaneous Biliary Tract InterventionsRadioGraphics2017Volume: 37Issue: 2pp. 665-680Secretin-enhanced MR Imaging of the PancreasRadiology2016Volume: 279Issue: 1pp. 29-43See More RSNA Education Exhibits Multimodality Imaging Review of Etiopathogenesis and Radiological Appearances of Biliary Strictures and Non-Surgical InterventionsDigital Posters2018Choosing the Best Test for Biliary Imaging: Re-Examining the Role of MRCPDigital Posters2019From Anatomy to Pathology: An Insight Into the Role of Imaging in Pediatriic Cholestasis—Let's Be a Part of the Treatment AlgorithmDigital Posters2020 RSNA Case Collection Necrotizing pancreatitisRSNA Case Collection2020Mirizzi SyndromeRSNA Case Collection2022Caroli SyndromeRSNA Case Collection2020 Vol. 37, No. 3 Metrics Altmetric Score PDF download

Spontaneous splenic artery aneurysm rupture in a 38-year old female: a case report

Splenic artery aneurysm (SAA) is a rare and extremely difficult diagnosis. A rare case of a ruptured SAA in a 38-year old female, firstly treated with endovascular embolization and then with splenectomy, is presented. A 38-year old female presented to the emergency department with epigastric pain and fainting episodes. Direct catheter angiography revealed a ruptured SAA and distal, as well as proximal coil embolization was performed. Due to abdominal compartment syndrome the patient underwent open surgery with splenic artery ligation and splenectomy. Postoperative she showed signs of sepsis and was treated with i.v. fluids, steroids, packed red blood cells, platelets, fresh frozen plasma and antimicrobial treatment. Additionally, a multidrug resistant Acinetobacter baumanni was yielded from the urine culture. She had a satisfactory recovery. She is followed up a total of 5 years with no signs of overwhelming post-splenectomy infection syndrome. Direct catheter angiography is a very helpful option in diagnosis, as well as treatment, but a close monitoring after embolization is essential. Furthermore, post-splenectomy sepsis is a severe disease with high mortality rates that requires immediate appropriate treatment.

Proximal Occlusion of Medium-Sized Vessels with the Penumbra Occlusion Device: A Study of Safety and Efficacy.

To retrospectively investigate the safety and efficacy of hybrid proximal coiling of various medium-sized vessels (4 to 8mm) using the Penumbra Occlusion Device (POD). From October 2014 to February 2016, 37 proximal embolizations were performed with PODs in 36 patients (mean age: 50.8, range: 10-86; 29 male, 7 female). Vessel occlusions were achieved under fluoroscopic guidance using a 2.7 French microcatheter. Among the 36 vessels targeted, 16 were splenic arteries, 11 renal arteries, 4 mesenteric arteries, 3 arteriovenous fistulae, 1 iliac artery, and 1 gonadal vein. Intermittent follow-up angiography was performed to assess the flow for final occlusion. Outcomes and complications were assessed by clinical and/or imaging follow-up. To produce proximal occlusion of the intended vessels, the POD was used alone in 19 embolizations (51.4%). In 12 procedures (32.4%), POD was used as a coil constrainer to secure the coil construct. In 6 procedures (16.2%), additional embolic devices were used to achieve vessel occlusion after initial POD deployment. After a mean follow-up of 3.2months, no POD migration was observed but two complications occurred (5.4%): one post embolic syndrome and one extensive infarction with splenic abscess. The POD system allows safe and effective proximal embolization of medium-sized vessels in a variety of clinical settings.

Endovascular Approach of a Proximal Anterior Inferior Cerebellar Artery Aneurysm: Case Report

Anterior inferior cerebellar artery (AICA) aneurysms are extremely rare, accounting for only 0.75% of all intracranial aneurysms. The average age of patients suffering from those aneurysms found in the literature was 44 years, with no significant difference between the sexes. These aneurysms can manifest clinically through expansive symptoms in cerebellopontine angle or through signs and symptoms of subarachnoid hemorrhage, such as nausea, vomiting, headache, nystagmus and paresis. The gold standard exam for diagnosis is cerebral angiography. The treatment of these lesions is controversial. The main difficulty of the surgical treatment of these aneurysms is the location of the AICA, which lies close to critical neurovascular structures. In this article, we describe a proximal AICA aneurysm embolization without occlusion of the parent artery, with excellent results in the postoperative period.

Risk Factor Analysis for Buttock Claudication after Internal Iliac Artery Embolization with Endovascular Aortic Aneurysm Repair.

Purpose:Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) involving the common iliac artery requires extension of the stent-graft limb into the external iliac artery. For this procedure, internal iliac artery (IIA) embolization is performed to prevent type II endoleak. In this study, we investigated the frequency and risk factor of buttock claudication (BC) in patients having interventional embolization of the IIA.Materials and Methods:From January 2010 to December 2013, a total of 110 patients with AAA were treated with EVAR in our institution. This study included 27 patients (24.5%) who had undergone unilateral IIA coil embolization with EVAR. We examined hospital charts retrospectively and interviewed by telephone for the occurrence of BC.Results:Mean age of total patients was 71.9±7.0 years and 88.9% were males. During a mean follow-up of 8.65±9.04 months, the incidence of BC was 40.7% (11 of 27 patients). In 8 patients with claudication, the symptoms had resolved within 1 month of IIA embolization, but the symptoms persisted for more than 6 months in the remaining 3 patients. In univariate and multivariate analysis, risk factors such as age, sex, comorbidity, patency of collateral arteries, and anatomical characteristics of AAA were not significantly related with BC.Conclusion:In this study, BC was a frequent complication of IIA embolization during EVAR and there was no associated risk factor. Certain principles such as checking preoperative angiogram, proximal and unilateral IIA embolization may have contributed to reducing the incidence of BC.

Preoperative Embolization in Spinal Tumour Surgery

Introduction Preoperative embolization has been shown to be effective in reducing intraoperative blood loss during metastatic spinal tumor surgery. However, the majority of studies investigating preoperative embolization for spinal metastases have preferentially selectedsecondaries fromrenal and thyroid as these are highly vascularized tumors. There is paucity of literature describing utility of embolization in other tumors. We aimed to determine the effect of preoperative embolization on intraoperative blood loss indifferent spinal tumors by type of surgical approaches. Materials and Methods We retrospectively evaluated 221 patients undergoing surgery for primary or metastatic spine tumors. Patients were analyzed for the effect of embolization agents, extent, level of embolization and timing between embolization & surgery, on estimated blood loss. Estimated blood loss and transfusion requirements were compared between embolized and non-embolized cases for different types of spinal tumor (metastatic lung, breast, renal, hepatocellular, thyroid, other epithelial tumors, myeloma/lymphoma and primary spine tumors) and surgical approaches (Type I: Cervical spine surgery either anterior and/or posterior stabilization with or without corpectomy, Type II: Thoracolumbar posterior instrumentation and decompression, and Type III: Thoracolumbar corpectomy). Results Preoperative embolization was performed in 48 patients. Hypervascular angiographic appearance was found in 22 (46%) and capillary blush in 26 (54%) embolized patients. Total embolization (>80% reduction of tumor blush) was achievable in more than half of the embolized patients (61%), and less amount of blood loss was observed in these patients (median blood loss = 900ml) compared with those who achieved partial (<50%) and subtotal (50–90%) embolization (1600ml and 1350ml respectively). Blood loss was also lower in those who achieved proximal embolization and those who underwent surgery between 13–24 hours after embolization. When stratified by type of tumor and surgical approaches, blood loss and transfusion requirement were lower in embolized cases of spinal secondaries from HCC & thyroid; and primary spine tumors. In multivariate linear regression, after adjusting for tumor type, type of surgical procedure, invasiveness index, preoperative haemoglobin and operative time, there were no significant differences in the blood loss as well as blood transfusion units between embolized and non-embolized groups. Conclusions Success of embolization in reducing blood loss depends on the extent of embolization, which should be total; and time interval between embolization and index surgery, which should be within 13–24 hours. Preoperative embolization is a useful modality in decreasing intraoperative blood loss in cases of spinal metastases from HCC, thyroid and primary spine tumors.

Splenic Artery Syndrome as a Possible Cause of Late Onset Refractory Ascites After Liver Transplantation: Management With Proximal Splenic Artery Embolization

BackgroundPortal hyperperfusion (PHP) is a hemodynamic condition which may develop after liver transplantation and cause refractory ascites (RA). The diagnosis is established by exclusion of other causes of increased sinusoidal pressure/resistance such as cellular rejection or toxicity and outflow obstruction. PHP as part of the pathogenesis of the splenic artery syndrome (SAS) can be treated with splenic artery embolization (SAE). MethodsThis is a retrospective study on a cohort of first-time whole-size liver transplant recipients diagnosed with RA due to PHP and treated by proximal SAE (pSAE) at the Liver Transplant Unit of the University Hospital of Udine between 2004 and 2014. ResultsFor this study, 23 patients were identified (prevalence 8%) and treated. Preliminary clinical workup to diagnose SAS was based on exclusion of other possible causes of RA with graft biopsy, cavogram with hepatic venous pressure measurement, computed tomography scan, and angiography. The pSAE was performed 110 ± 61 days after transplantation, and no procedure-related complications occurred. pSAE resulted in a significant decrease of portal vein velocity (P = .01) and wedge hepatic venous pressure (P = .03). The diameter of the spleen showed a slightly significant reduction (P = .047); no modification of hepatic artery resistive index were encountered (P = .34). Moreover, pSAE determined the resolution of RA in all cases. ConclusionspSAE is a safe and effective procedure to modulate the hepatic inflow and thus to treat RA secondary to SAS, with a low incidence of complications and a high rate of clinical response.

Rebleeding of a Splenic Artery Aneurysm after Coil Embolisation.

Background. Splenic artery aneurysm (SAA) is an uncommon and difficult diagnosis. SAA is more common in females. Only 20% of SAA is symptomatic and may present as a rupture. A ruptured SAA is associated with a 25% mortality rate. Case Presentation. We present a case of a male patient with a bleeding SAA that rapidly increased in size. Distal coiling was technically impossible and despite proximal coil embolisation the SAA continued to bleed. A laparotomy including splenectomy and partial pancreatectomy was performed with an uneventful patient recovery. Discussion. Endovascular management is currently considered the optimal treatment of SAA. However, careful monitoring and follow-up is needed after embolisation as rapid recanalization of the SAA may possibly occur, especially when distal coiling of the aneurysm is unsuccessful. Conclusion. Endovascular treatment of an SAA is not necessarily effective. Surgeons must be prepared to perform open procedures to further reduce mortality rates.

Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients.

ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.

Proximal Embolization of the Splenic Artery with a Penumbra Occlusion Device (POD): A Novel Occlusion Technique for Blunt Splenic Injuries.

Proximal Embolization of the Splenic Artery with a Penumbra Occlusion Device (POD): A Novel Occlusion Technique for Blunt Splenic Injuries.

Occlusion of the Internal Iliac Artery Is Associated with Smaller Prostate and Decreased Urinary Tract Symptoms

PurposeTo characterize the relationship of proximal internal iliac artery (IIA) occlusion or embolization on prostate volume (PV) and the presence of lower urinary tract symptoms (LUTS) or benign prostatic hyperplasia (BPH). Materials and MethodsThe study included 2 parts: Part 1 comprised 99 men ≥ 50 years old who underwent abdominopelvic computed tomography angiography for lower extremity claudication assessed in a retrospective cohort design; Part 2 comprised 18 patients who underwent iatrogenic IIA embolization during endovascular aneurysm repair assessed by a within-subjects approach. Prostate volume and IIA origin diameter were measured; IIA occlusion was noted. Chart review documented body mass index, LUTS, impotence, and buttock claudication. ResultsOf 99 men in Part 1, 60 had no IIA occlusion, and 39 had IIA occlusion (17 unilateral, 22 bilateral). Prostate volume differed significantly between groups (no IIA occlusion, 27.3 mL; unilateral IIA occlusion, 20.7 mL; bilateral IIA occlusion, 17.1 mL; P = .001). Men without IIA occlusion had more LUTS (27%) than men with IIA occlusion (10%; P = .04). The number of men with complaints of impotence or buttock claudication was similar in both groups (40% vs 46%; P > .05). Multiple regression showed that age and IIA occlusion were independent predictors of PV (P < 0.05), whereas body mass index was not (P > .05), and that IIA occlusion was the only independent predictor of LUTS/BPH (P < .05). Among the 18 men in Part 2, PV declined by 29% after embolization (P = .00001); 6 men had improvement or resolution of LUTS. ConclusionProximal IIA occlusion is associated with nearly one-third reduction in PV and decreased findings of LUTS/BPH.

Proximal Splenic Artery Embolization in Chemotherapy-Induced Thrombocytopenia: A Retrospective Analysis of 13 Patients

PurposeTo determine if proximal splenic artery embolization (PSAE) provides a safe and effective alternative to alleviate chemotherapy-induced thrombocytopenia (CIT), allowing patients with cancer to resume chemotherapy regimens. Materials and MethodsThirteen patients (9 men, 4 women; mean age, 63 y) with underlying malignancy (pancreatic adenocarcinoma, n = 6; cholangiocarcinoma, n = 5; other, n = 2) complicated by CIT underwent PSAE. Mean platelet counts were calculated before the initiation of chemotherapy, at the nadir that resulted in discontinuation of chemotherapy before the PSAE procedure, at peak values after the procedure, and at a mean follow-up of 9.2 months. The time to reinitiation of chemotherapy after PSAE was calculated. ResultsBaseline platelet count before initiation of chemotherapy was 162 × 109/L (range, 90–272 × 109/L). The platelet count nadir resulting in cessation of chemotherapy was 45 × 109/L (range, 23–67 × 109/L), and the pre-PSAE platelet count was 88 × 109/L (range, 49–131 × 109/L). The post-PSAE peak platelet count improved significantly (to 209 × 109/L; range, 83–363 × 109/L) compared with the nadir counts and the pre-PSAE counts (P < .01) at a mean short-term follow-up of 35 days (range, 7–91 d). The counts at follow-up to 9.2 months (range, 3–15 mo) were 152 × 109/L (range, 91–241 × 109/L). All patients became eligible to resume chemotherapy. The time to initiation of chemotherapy after PSAE averaged 22 days (range, 4–58 d) in 12 patients; one patient declined chemotherapy. ConclusionsProximal splenic artery embolization appears to be safe and effective in alleviating CIT, allowing resumption of systemic chemotherapy. Further studies may help guide patient selection by identifying characteristics that allow a sustained improvement in thrombocytopenia.

Combination proximal pulmonary artery coiling and distal embolization induces chronic elevations in pulmonary artery pressure in Swine.

Pulmonary hypertension (PH) is associated with aberrant vascular remodeling and right ventricular (RV) dysfunction that contribute to early mortality. Large animal models that recapitulate human PH are essential for mechanistic studies and evaluating novel therapies; however, these models are not readily accessible to the field owing to the need for advanced surgical techniques or hypoxia. In this study, we present a novel swine model that develops cardiopulmonary hemodynamics and structural changes characteristic of chronic PH. This percutaneous model was created in swine (n=6) by combining distal embolization of dextran beads with selective coiling of the lobar pulmonary arteries (2 procedures per lung over 4 weeks). As controls, findings from this model were compared with those from a standard weekly distal embolization model (n=6) and sham animals (n=4). Survival with the combined embolization model was 100%. At 8 weeks after the index procedure, combined embolization procedure animals had increased mean pulmonary artery pressure (mPA) and pulmonary vascular resistance (PVR) compared to the controls with no effect on left heart or systemic pressures. RV remodeling and RV dysfunction were also present with a decrease in the RV ejection fraction, increase in the myocardial performance index, impaired longitudinal function, as well as cardiomyocyte hypertrophy, and interstitial fibrosis, which were not present in the controls. Pulmonary vascular remodeling occurred in both embolization models, although only the combination embolization model had a decrease in pulmonary capacitance. Taken together, these cardiopulmonary hemodynamic and structural findings identify the novel combination embolization swine model as a valuable tool for future studies of chronic PH.

Bypass and embolization for a vertebral artery aneurysm in a patient with Marfan syndrome.

Extracranial vertebral artery aneurysms represent an uncommon presentation of collagen vascular disease. We performed staged proximal embolization of large left vertebral artery aneurysm after distal common carotid-to-vertebral bypass at C2 in a young adult patient with Marfan syndrome and a hypoplastic contralateral vertebral artery. Dilation of the autogenous saphenous vein graft occurred at 1 year with proximal graft stenosis requiring operative revision. Subsequent dilation of the basilar artery led to symptoms of pontine compression at 18 months that have resolved at 31 months of follow-up.

The safety and efficacy of proximal splenic artery embolization after liver transplantation are still not clearly defined

1Liver Unit, Liver Transplantation and Hepato‐Pancreato‐Biliary SurgeryQueen Elizabeth HospitalBirminghamUnited Kingdom *Address reprint requests to Paolo Muiesan, Liver Unit, Liver Transplantation and Hepato‐Pancreato‐Biliary Surgery, Queen Elizabeth Hospital, 3rd Floor, Nuffield House, Edgbaston, B15 2TH Birmingham, United Kingdom. Telephone: 44‐0‐121‐627‐2418; E‐mail: [email protected]

Abstract No. 345 - Endovascular management of splenic trauma: a review of principles and techniques

1) Discuss the epidemiology and mechanisms of splenic trauma. 2) Review pertinent imaging findings on CT and the American Association for the Surgery of Trauma (AAST) grading scale for splenic injuries. 3) Highlight techniques and principles for endovascular embolization of acute splenic trauma. 4) Discuss follow-up care, post-embolization imaging, and potential complications. Splenic injuries most commonly occur due to blunt force trauma following motor vehicle accidents. While splenic trauma has been historically managed with splenectomy or splenorrhaphy, splenic arterial embolization has become the principal treatment in hemodynamically stable patients. Because of an extensive network of collateral vessels supplying the spleen, proximal or distal embolization maybe employed for endovascular management of splenic injuries. This exhibit reviews the pertinent anatomy and angiographic evaluation of splenic artery embolization. Depending on the initial angiographic findings, proximal or distal embolization maybe performed each with differing techniques and underlying principles. A variety of factors should be considered when choosing the site of embolization as well as the embolic agent utilized. Case based examples of active extravasation, pseudoaneurysms, and splenic artery aneurysms managed with coiling, microparticle, vascular plug, and gel foam embolization will be highlighted using quality images. Close postprocedure care is essential as delayed splenic rupture, splenic abscess, and other complications may occur. Guidelines for vaccination and timing of follow-up CT will be included. Splenic injuries due to blunt force trauma are being increasingly treated with endovascular embolization forgoing the need for operative management. Appropriate utilization of proximal and distal embolization techniques performed with a variety of embolic agents is essential to achieve safe and effective patient outcomes.

Abstract No. 341 - Proximal versus distal splenic artery embolization prior to splenectomy for hypersplenism

Abstract No. 341 - Proximal versus distal splenic artery embolization prior to splenectomy for hypersplenism

Epstein-Barr Virus-Associated Atraumatic Spleen Laceration Presenting with Neck and Shoulder Pain.

Patient: Male, 15Final Diagnosis: Infectious Mononucleosis induced spleen laceratioSymptoms: Fever • headache • neck pain and upper shoulder pain which was worse with flexion and extensionMedication: —Clinical Procedure: Splenic angiogram and proximal splenic artery embolization techniqueSpecialty: Critical Care MedicineObjective:Unusual clinical courseBackground:Infectious mononucleosis, caused by the Epstein-Barr virus (EBV), is a common infection with worldwide distribution; more than 90% of people have been infected by adulthood. One of the most feared, albeit rare, complications, occurring in less than 0.5% of those infected, is splenic injury or rupture.Case Report:A febrile 15-year-old male presented to the emergency department with the chief compliant of headache, neck pain, and upper shoulder pain. He did not recall any specific traumatic injury. His abdomen was soft, nondistended, and was tender in the right and left lower quadrants. Right lower quadrant ultrasound demonstrated non-visualization of the appendix, moderate right lower quadrant free fluid, and positive McBurney’s sign.CT of the abdomen and pelvis was ordered, which demonstrated moderate splenomegaly, with findings compatible with laceration through the anterior aspect of the spleen, with moderate hemoperitoneum. Monospot was negative and EBV panel demonstrated IGG negative, IGM positive, and, IGG negative.The patient was transferred to interventional radiology for a splenic angiogram and proximal splenic artery embolization. The angiogram demonstrated grade 3 laceration with moderate hemoperitoneum and no active extravasation or evidence of pseudoaneurysm. The patient was admitted and made a prompt recovery without any other sequelae.Conclusions:The presentation of splenic injury or rupture can vary; the patient may complain of abdominal pain or left upper quadrant pain, may exhibit referred left shoulder pain when the LUQ is palpated (Kehr’s Sign), or may exhibit hemodynamic instability. Given the spectrum of non-specific symptoms, diagnosing EBV-induced splenic laceration can be difficult.

A Case Similar to Small-for-size Syndrome Successfully Treated by Proximal Splenic Artery Embolization After Living-donor Liver Transplantation

A Case Similar to Small-for-size Syndrome Successfully Treated by Proximal Splenic Artery Embolization After Living-donor Liver Transplantation

Nonoperative management of blunt splenic injury in adults: there is (still) a long way to go. The results of the Bologna-Maggiore Hospital trauma center experience and development of a clinical algorithm.

Non-operative management (NOM) of hemodynamically stable patients with blunt splenic injury (BSI) is the standard of care, although it is associated with a potential risk of failure. Hemodynamically unstable patients should always undergo immediate surgery and avoid unnecessary CT scans. Angioembolization might help to increase the NOM rates, as well as NOM success rates. The aim of this study was to review and critically analyze the data from BSI cases managed at the Maggiore Hospital Trauma Center during the past 5 years, with a focus on NOM, its success rates and outcomes. A further aim was to develop a proposed clinical practical algorithm for the management of BSI derived from Clinical Audit experience. During the period between January 1, 2009 and December 31, 2013 we managed 293 patients with splenic lesions at the Trauma Center of Maggiore Hospital of Bologna. The data analyzed included the demographics, clinical parameters and characteristics, diagnostic and therapeutic data, as well as the outcomes and follow-up data. A retrospective evaluation of the clinical outcomes through a clinical audit has been used to design a practical clinical algorithm. During the five-year period, 293 patients with BSI were admitted, 77 of whom underwent immediate surgical management. The majority (216) of the patients was initially managed non-operatively and 207 of these patients experienced a successful NOM, with an overall rate of successful NOM of 70 % among all BSI cases. The success rate of NOM was 95.8 % in this series. All patients presenting with stable hemodynamics underwent an immediate CT-scan; angiography with embolization was performed in 54 cases for active contrast extravasation or in cases with grade V lesions even in absence of active bleeding. Proximal embolization was preferentially used for high-grade injuries. After a critical review of the cases treated during the past 5 years during a monthly clinical audit meeting, a clinical algorithm has been developed with the aim of standardizing the clinical management of BSI by a multidisciplinary team to include every patient within the correct diagnostic and therapeutic pathway, in order to improve the outcomes by potentially decreasing the NOM failure rates and to optimize the utilization of resources.