Splenic Artery Embolization Research Articles

Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy-An Ancillary Study.

The spleen is the most commonly injured organ in blunt abdominal trauma. Its management depends on hemodynamic stability. According to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS ≥ 3), stable patients with high-grade splenic injuries may benefit from preventive proximal splenic artery embolization (PPSAE). This ancillary study, using the SPLASH multicenter randomized prospective cohort, evaluated the feasibility, safety, and efficacy of PPSAE in patients with high-grade blunt splenic trauma without vascular anomaly on the initial CT scan. All patients included were over 18 years old, had high-grade splenic trauma (≥AAST-OIS 3 + hemoperitoneum) without vascular anomaly on the initial CT scan, received PPSAE, and had a CT scan at one month. Technical aspects, efficacy, and one-month splenic salvage were studied. Fifty-seven patients were reviewed. Technical efficacy was 94% with only four proximal embolization failures due to distal coil migration. Six patients (10.5%) underwent combined embolization (distal + proximal) due to active bleeding or focal arterial anomaly discovered during embolization. The mean procedure time was 56.5 min (SD = 38.1 min). Embolization was performed with an Amplatzer™ vascular plug in 28 patients (49.1%), a Penumbra occlusion device in 18 patients (31.6%), and microcoils in 11 patients (19.3%). There were two hematomas (3.5%) at the puncture site without clinical consequences. There were no rescue splenectomies. Two patients were re-embolized, one on Day 6 for an active leak and one on Day 30 for a secondary aneurysm. Primary clinical efficacy was, therefore, 96%. There were no splenic abscesses or pancreatic necroses. The splenic salvage rate on Day 30 was 94%, while only three patients (5.2%) had less than 50% vascularized splenic parenchyma. PPSAE is a rapid, efficient, and safe procedure that can prevent splenectomy in high-grade spleen trauma (AAST-OIS) ≥ 3 with high splenic salvage rates.

Splenic Artery Embolization in Conservative Management of Blunt Splenic Injury Graded by 2018 AAST-OIS: Results from a Hospital in Vietnam.

This study was conducted to evaluate the results of conservative management of blunt splenic trauma according to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) in 2018 by embolization. This observational study included 50 patients (42 men and 8 women) with splenic injury who underwent multidetector computed tomography (MDCT) and embolization. According to the 2018 AAST-OIS, 27 cases had higher grades than they did according to the 1994 AAST-OIS. The grades of two cases of grade II increased to grade IV; those of 15 cases of grade III increased to grade IV; and four cases of grade IV increased to grade V. As a result, all patients underwent successful splenic embolization and were stable at discharge. No patients required re-embolization or conversion to splenectomy. The mean hospital stay was 11.8±7 days (range, 6-44 days), with no difference in length of hospital stay among grades of splenic injury (p >0.05). Compared with the AAST-OIS 1994, the AAST-OIS 2018 classification is useful in making embolization decisions, regardless of the degree of blunt splenic injury with vascular lacerations visible on MDCT.

Safety and efficacy of splenic artery embolization for the treatment of gastric variceal bleeding secondary to left-sided portal hypertension

Safety and efficacy of splenic artery embolization for the treatment of gastric variceal bleeding secondary to left-sided portal hypertension

Splenic artery pathology presentation, operative interventions, and outcomes in 88 patients with vascular Ehlers-Danlos syndrome

ObjectiveVascular Ehlers-Danlos syndrome (VEDS) is rare and associated with arteriopathies. The aim of this study is to investigate the presentation, operative interventions, and outcomes of splenic arterial pathology in a population of more than 1500 individuals with genetically confirmed VEDS due to pathogenic COL3A1 variants. MethodsCross-sectional analysis of 1547 individuals was performed. The data were assembled by harmonizing data from three overlapping cohorts with genetically confirmed VEDS: the VEDS Collaborative Natural History Study (N = 242), a single-center cohort (N = 75), and the University of Washington Collagen Diagnostic Lab cohort (N = 1231). Duplicates were identified and removed. Patients were selected for analysis if they had splenic artery aneurysm (SAA), pseudoaneurysm, dissection, thrombosis, or rupture. Demographics, COL3A1 variants, interventions, and outcomes were analyzed. Comparisons by splenic artery rupture were made. ResultsA total of 88 patients presented between 1992 and 2021 with splenic artery pathology (5.7% of the cohort; mean age at diagnosis, 37 ± 11.1 years; 50% male). One-third were diagnosed with VEDS prior to the splenic artery pathology diagnosis, and 17% were diagnosed post-mortem. Most had a positive family history (61%). Most had COL3A1 variants associated with minimal normal collagen production (71.6%). Median follow up was 8.5 years (interquartile range, 0.9-14.7 years). Initial presentation was rupture in 47% of the cases. Splenic artery rupture overall was 51% (n = 45), including four cases of splenic rupture. There were no major differences in VEDS-related manifestations or COL3A1 variant type by rupture status. SAA was noted in 39% of the cases. Only 12 patients had splenic artery diameter documented in 12 cases with a median diameter of 12 mm (interquartile range, 10.3-19.3 mm). A total of 34 patients (38.6%) underwent 40 splenic arterial interventions: 21 open surgical, 18 embolization, and one unknown procedure. More than one splenic artery intervention was performed in five cases (14.7%). Open repair complications included arteriovenous fistula (n = 1), intestinal or pancreatic injury (n = 1 each), and four intraoperative deaths. There were no deaths or access site complications related to splenic artery embolization. Four patients (23.5%) developed a new SAA in the remaining splenic artery post embolization. All-cause mortality was 35% (n = 31), including 22 related to a ruptured splenic artery. ConclusionsSplenic arteriopathy in VEDS is associated with variants that affect the structure and secretion of type III collagen and frequently present with rupture. Rupture and open repair are associated with high morbidity and mortality, whereas embolization is associated with favorable outcomes. Suggest repair considerations at SAA diameter of 15 mm. Long-term follow-up is indicated as secondary splenic arteriopathy can occur.

Open Thoracic Drainage Followed by Proximal Splenic Artery Embolization for Massive Hydrothorax Before Living Donor Liver Transplantation

Hepatic hydrothorax is associated with postoperative infectious complications and mortality in patients undergoing living-donor liver transplantation (LDLT). Thus, preoperative management of massive hepatic hydrothorax is essential for improving the outcomes of LDLT. This study aimed to demonstrate our successful cases and strategy for treating massive hepatic hydrothorax. Our strategy for hepatic hydrothorax includes (a) mini-thoracotomy under general anesthesia for the drainage of hydrothorax, (b) preoperative hepatic inflow modulation by proximal splenic arterial embolization, and (c) nutritional and physical intervention to improve the general condition. Two patients with massive hepatic hydrothorax were treated with our strategy. Both patients had end-stage liver disease secondary to primary biliary cholangitis. Their performance status deteriorated due to massive hydrothorax. After the intervention, their performance status significantly improved. After that, LDLTs with right lobe grafts were performed. The duration of the operation was 440 and 343 minutes, with an intraoperative blood loss of 1,700 and 1,600 g, respectively. Their postoperative courses were uneventful, and they were discharged on postoperative days 16 and 14. Our pre-LDLT multimodal management strategy for massive hepatic hydrothorax, including preoperative open thoracic drainage, pre-LDLT portal inflow modulation, and nutritional intervention, improved the preoperative condition of patients undergoing LDLT, resulting in successful outcomes.

Retrospective Evaluation of Splenic Artery Embolization Outcomes in the Management of Blunt Splenic Trauma: A Single Centre Experience at a Large Level 1 Trauma Centre.

Retrospective review of splenic artery embolization (SAE) outcomes performed for blunt abdominal trauma. 11-year retrospective review at a large level-1 Canadian trauma centre. All patients who underwent SAE after blunt trauma were included. Technical success was defined as angiographic occlusion of the target vessel and clinical success was defined as successful non-operative management and splenic salvage on follow-up. 138 patients were included of which 68.1% were male. The median age was 47years (interquartile range (IQR) = 32.5years). The most common mechanisms of injury were motor vehicle accidents (37.0%), mechanical falls (25.4%), and pedestrians hit by motor vehicles (10.9%). 70.3% of patients had American Association for the Surgery of Trauma (AAST) grade 4 injuries. Patients were treated with proximal SAE (n = 97), distal SAE (n = 23) or combined SAE (n = 18), and 68% were embolized with an Amplatzer plug. No significant differences were observed across all measures of hospitalization (Length of hospital stay: x2(2) = .358, P = .836; intensive care unit (ICU) stay: x2(2) = .390, P = .823; ICU stay post-procedure: x2(2) = 1.048, P = .592). Technical success and splenic salvage were achieved in 100% and 97.8% of patients, respectively. 7 patients (5%) had post-embolization complications and 7 patients (5%) died during hospital admission, but death was secondary to other injuries sustained in the trauma rather than complications related to splenic injury or its management. We report that SAE as an adjunct to non-operative management of blunt splenic trauma can be performed safely and effectively with a high rate of clinical success.

Вплив перманентного стресу, обумовленого війною в Україні, на стан пацієнтів після перенесених стравохідних кровотеч портального ґенезу

Purpose - to assess the impact of permanent stress caused by the war in Ukraine on the condition of patients after portal esophageal bleeding. Materials and methods. The study included 37 patients with a confirmed diagnosis of liver cirrhosis complicated by portal hypertension and esophageal variceal bleeding. The Group 1 included patients who underwent endoscopic band ligation of bleeding varices and partial splenic artery embolization 1 month after the bleeding. The Group 2 included patients who underwent only endoscopic band ligation. Patients of the Groups 1 and 2 underwent all stages of the study before the start of the war in Ukraine. The Group 3 included patients who had a bleeding episode within 1 month before the start of the war. In dynamics, the levels of laboratory indicators of the functional state of the liver and the quality of life according to the SF-36 questionnaire of patients were evaluated. Results. In the Group 1, there was a reliable progressive improvement of all studied indicators over time. In the Group 2, there was a reliable improvement of all indicators in the period between the first and second visits, with their subsequent slight negative dynamics, but without statistical reliability. In the Group 3, the dynamics of changes in all studied laboratory indicators on the first four visits generally repeated that in the Group 2. On the fifth visit, the numerical values of almost all studied indicators were higher than the initial values, although the differences were not statistically significant. As for the quality of life, on the second visit there was a significant increase in the indicators of the physical component of health and a decrease in the indicators of the psychological component of health. Subsequently, a decrease in the values of both indicators in comparison with the values on the second visit was observed. On the fifth visit, there was an increase in indicators of the psychological component of health. Conclusions. The stay of patients after portal esophageal bleeding in a state of permanent stress leads to the deterioration of the psychological component of health from the very beginning of the action of stressful factors, followed by a gradual decrease in the physical component of health. The cumulative effect of permanent stress leads to the objectification of changes in the physical condition of such patients, which is manifested by the deterioration of indicators of the functional state of the liver. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Analysis of Need for Intervention in Low-Grade Traumatic Splenic Injury.

Blunt splenic injuries are common traumatic injuries. Severe injuries may require blood transfusion, procedural, or operative intervention. Conversely, patients with low-grade injuries and normal vital signs frequently do not require intervention. The level and duration of monitoring required to safely manage these patients are unclear. We hypothesize that low-grade splenic trauma has a low rate of intervention and may not require acute hospitalization. This retrospective descriptive analysis included patients admitted to a level I trauma center with low injury burden (injury severity score <15) and The American Association for the Surgery of Trauma (AAST) grade 1 (G1) and 2 (G2) splenic injuries between January 2017 and December 2019 using the Trauma Registry of the American College of Surgeons (TRACS). The primary outcome was the need for any intervention. Secondary outcomes included time to intervention and length of stay. 107 patients met inclusion criteria. 87.9% required no intervention . 9.4% required blood products, with a median time to transfusion of 7.4hours from arrival. All patients receiving blood products had extenuating circumstances such as bleeding from other injuries, anticoagulant use, or medical comorbidities. 2 patients required splenic artery embolization, one presenting with return precautions 9days post-injury and 1 with significant comorbidities. One patient with concomitant bowel injury required splenectomy. Low-grade blunt splenic trauma has a low rate of intervention, which typically occurs within the first 12hours of presentation. This suggests that outpatient management with return precautions may be appropriate for select patients after a short interval of observation.

Comparison of outcomes of proximal versus distal and combined splenic artery embolization in the management of blunt splenic injury: a report of 202 cases from a single trauma center

BackgroundTo compare the outcomes of blunt splenic injuries (BSI) managed with proximal (P) versus distal (D) versus combined (C) splenic artery embolization (SAE).MethodsThis retrospective study included patients with BSI who demonstrated vascular injuries on angiograms and were managed with SAE between 2001 and 2015. The success rate and major complications (Clavien–Dindo classification ≥ III) were compared between the P, D, and C embolizations.ResultsIn total, 202 patients were enrolled (P, n = 64, 31.7%; D, n = 84, 41.6%; C, n = 54, 26.7%). The median injury severity score was 25. The median times from injury to SAE were 8.3, 7.0, and 6.6 h for the P, D, and C embolization, respectively. The overall haemostasis success rates were 92.6%, 93.8%, 88.1%, and 98.1% in the P, D, and C embolizations, respectively, with no significant difference (p = 0.079). Additionally, the outcomes were not significantly different between the different types of vascular injuries on angiograms or the materials used in the location of embolization. Splenic abscess occurred in six patients (P, n = 0; D, n = 5; C, n = 1), although it occurred more commonly in those who underwent D embolization with no significant difference (p = 0.092).ConclusionsThe success rate and major complications of SAE were not significantly different regardless of the location of embolization. The different types of vascular injuries on angiograms and agents used in different embolization locations also did not affect the outcomes.Graphical abstract

Partial Splenic Artery Embolization in the Management of Acute Immune Thrombocytopenia Refractory to Medical Treatment

Our case details a 60-year-old man with cirrhosis from hepatitis C referred to hematology for severe thrombocytopenia after right hemiglossectomy in the setting of squamous cell tongue cancer. Acute immune thrombocytopenia was diagnosed. Platelet transfusions, high-dose steroids, intravenous immunoglobulin ×2, romiplostim, and rituximab were administered without adequate platelet response (2000/µL), and patient developed gastrointestinal bleeding. Partial splenic artery embolization was performed urgently for refractory thrombocytopenia resulting in ∼60% splenic infarction. His platelet count increased in the next few days and was sustained. Our case demonstrates partial splenic artery embolization as an underused approach to severe thrombocytopenia in the setting of acute immune thrombocytopenia resistant to steroids and medications.

Proximal Splenic Artery Embolization for Refractory Ascites and Hydrothorax Post-Liver Transplant.

Proximal splenic artery embolization (pSAE) has been advocated as a valuable tool to ameliorate portal hyper-perfusion (PHP). The purpose of this study was to determine the safety and efficacy of pSAE to treat refractory ascites (RA) and/or refractory hydrothorax (RH) in the setting of PHP post-liver transplant. A total of 30 patients who underwent pSAE for RA and/or RH after liver transplantation (LT) between January 2007 and December 2017 were analyzed retrospectively. The patients were divided into groups according to the time frame from pSAE to clinical resolution in order to identify predictors of RA/RH response to the procedure. Twenty-four (80%) patients responded to pSAE within three months, whereas 6 (20%) still required additional treatments for RA/RH at three months post-pSAE. In all cases clinical symptoms resolved within six months. Complications after pSAE were as follows: 2 cases of splenic infarction (6.6%), one case of post-splenic embolization syndrome (3.3%), one case of hepatic artery thrombosis (3.3%) and one case of portal vein (PV) thrombosis (3.3%). Increased intraoperative PV flow volume and increased pre-pSAE PV velocity, as well as higher estimated glomerular filtration rate were associated with early RA/RH resolution. pSAE is safe and effective in treating RA and RH due to PHP after LT. This study suggests that clinical parameters indicating more severe PHP and better kidney function are possible predictors for early response to pSAE.

Life-threatening "hyper-progression" on immunotherapy revealed as pseudo-progression in DNA mismatch repair deficiency: a case report.

Distinguishing pseudo-progression from true progression on immunotherapy remains a clinical challenge. Clinical tools to aid in this task are currently lacking. DNA mismatch repair (MMR) status is a known predictive marker for anti-programmed death (PD)-1 therapy, but its role in helping to address this situation is not well-defined. We report the first case, to our knowledge, of life-threatening hyper-progression which was later revealed to be pseudo-progression in a patient with a deficient MMR (dMMR) tumor. We describe a 62-year-old man with advanced dMMR gastric cancer who was being treated with pembrolizumab monotherapy. After three doses of pembrolizumab he exhibited signs and symptoms that met all applicable definitions of hyper-progression in the setting of acute life-threatening gastrointestinal hemorrhage, extensive radiographic progression of metastases, and increasing carcinoembryonic antigen (CEA). Comfort measures were considered given the appearance of hyper-progression. But partly given the patient's request, aggressive support was provided, including blood products, vasopressors, and splenic artery embolization. His condition improved, and subsequent scans revealed regression of his metastases and decreased CEA, confirming pseudo-progression. Pembrolizumab was restarted. The patient remains on pembrolizumab with minimal tumor burden more than one year later. This case demonstrates that life-threatening hyper-progression can represent pseudo-progression and suggests that MMR status could be important to consider in determining the aggressiveness of clinical management during apparent hyper-progression.

Endoscopic ultrasound related partial splenic artery embolization: A gifted outcome.

Endoscopic ultrasound related partial splenic artery embolization: A gifted outcome.

Treatment of stage IIb hepatocellular carcinoma with portal hypertension by sequential therapy of main splenic artery embolization and liver and spleen microwave ablation: A case report

Treatment of stage IIb hepatocellular carcinoma with portal hypertension by sequential therapy of main splenic artery embolization and liver and spleen microwave ablation: A case report

Proximal splenic artery embolization using a vascular plug in grade IV or V splenic trauma – a single centre 11-year experience

Proximal splenic artery embolization using a vascular plug in grade IV or V splenic trauma – a single centre 11-year experience

Clinical outcomes of splenic arterial embolization for blunt splenic injury in pediatric and adolescent patients.

Splenic arterial embolization (SAE) is an effective intervention for the management of arterial hemorrhage asso-ciated with blunt splenic injury. However, its role and clinical outcomes in pediatric and adolescent patients are unclear. The aim of this study is to assess the role and the clinical outcomes of SAE for blunt splenic injuries in pediatric and adolescent trauma patients. A retrospective cohort study was performed in patients aged ≤17 years with blunt splenic injury transferred to a re-gional trauma center in a tertiary referral hospital between November 01, 2015, and September 30, 2020. The final study population consisted of 40 pediatric and adolescent patients with blunt splenic injuries. The patient demographics, mechanisms of injury, details of injuries, angiographic findings, embolization techniques, and technical and clinical outcomes, including spleen salvage rates and pro-cedure-related complications, were examined. Of the 40 pediatric and adolescent patients with blunt splenic injury, 17 underwent SAE (42.53%). The clinical success rate was 88.2% (15/17). No cases of embolization-related complications or clinical failure were observed. Spleen salvage after SAE was achieved in all patients. In addition, no statistically significant differences were observed in clinical outcomes (clinical success and spleen salvage rates) between low-grade (World Society of Emergency Surgery [WSES] spleen trauma classification I or II) and high-grade (WSES classification III or IV) splenic injury groups. SAE is a safe and feasible procedure, and is effective for successful spleen salvage of blunt splenic injuries in pediatric and adolescent patients.

THE FACTOR ANALYSIS OF THE RESULTS OF MODERN TREATMENT OF PATIENTS WITH LIVER CIRRHOSIS WITH PORTAL HYPERTENSION

The purpose of this study is to study and evaluate the results of conventional methods of endovascular and endoscopic treatment of patients with complicated portal hypertension. Methods. In our study until 2021, 56 patients were included for analysis. In the course of the research, in 12 cases the endovascular method of percutaneous hepatic embolization of esophagus and gastric varicose vein in combination with splenic artery embolization, endoscopic sclerotherapy method in 23 cases, and endoscopic ligation according to the traditional method in 21 cases were used. The result of research work has showed that isolated use of endovascular methods (left gastric vein embolization, splenic artery embolization) in patients with liver cirrhosis is characterized by a low 2-year survival rate - 14.2%, with frequent anatomical and technical complications of this procedure - up to 64.7%, unstable primary hemostasis – 40.4%, esophagus and gastric varicose vein are explained by a high rate of recurrence of bleeding from varicose veins – 67.4%, risk of death – 21.8%. Conclusions. The clinical advantages of EL compared to different methods of ES have been achieved in terms of the rate of ineffective primary hemostasis, the risk of recurrence of bleeding from EGVV, short-term and long-term results, as well as improved 2-year survival rates. However, in general, their isolated use is associated with a relatively low chance of complete prevention of exacerbation of hemorrhagic syndrome relapses, which makes it possible to choose a combined approach to the treatment of patients with LC with PH and risk of bleeding from EGVV requires the development of tactical algorithms. In endovascular transhepatic embolization of esophageal and gastric varices, good results of treatment in the follow-up period of up to 2 years were very low, while unsatisfactory results of ES prevailed over good results, in turn, the best results were observed in the EL group. The results of endovascular transhepatic embolization in EGVV remain unknown in 1/3 of the studies.

Partial splenic artery embolization for treatment of Hypersplenism in portal hypertension: Experience from tertiary referral centre

Partial splenic artery embolization for treatment of Hypersplenism in portal hypertension: Experience from tertiary referral centre

A patient on maintenance hemodialysis with improvement of cytopenia after partial splenic artery embolization for hepatic cirrhosis-associated hypersplenism：A case report

症例は63歳女性．肝硬変や慢性腎不全で当院に通院中であった．貧血と血小板減少を認め，3年前に他院血液内科で精査され，肝硬変に伴う脾機能亢進症と診断された．2年前に血液透析導入となり，貧血に対し赤血球造血刺激因子製剤を投与されたが，効果は不十分であった．頻回の赤血球輸血によっても貧血の是正が困難となったため，当科入院のうえ部分的脾動脈塞栓術（partial splenic embolization：PSE）を施行した．2か月後に脾膿瘍を発症したがドレナージと抗菌薬の投与で軽快し，以後の輸血は不要となった．維持血液透析患者に合併した脾機能亢進症に対しPSEを施行した既報は少なく，その有用性を示唆する症例と考えられ報告する．

RADIOLOGICAL MANAGEMENT OF SPLENIC ARTERY INJURY FOLLOWING ROUTINE COLONOSCOPY

Colonoscopies can be used for both interventional and dialogistic purposes. The use of colonoscopies is not without risk and an awareness of these risks, as well as the clinical presentation of these risks / adverse effects, is vital to ensure optimal patient care is achieved both throughout and after the procedure. We present a case of a 49-year-old patient who presented to a district general hospital within the National Health Service (NHS) with diffuse abdominal pain and haemodynamic instability following a colonoscopy. A splenic artery injury was identified following a computerized tomography (CT) scan with contrast, of the abdomen and pelvis of the patient. The patient was resuscitated and managed without the need of surgical intervention in the form of targeted splenic artery embolization. This case highlights that a high index of suspicion of splenic injury should be held by the clinical in any patient who presents with abdominal pain with or without haemodynamic instability as early intervention is key to good patient outcomes.