Complications arising from splenic artery embolization: a review of an 11-year experience

Ekeh, Akpofure Peter; Khalaf, Shaden; Ilyas, Sadia; Kauffman, Shannon; Walusimbi, Mbaga S.; McCarthy, Mary C.

doi:10.1016/j.amjsurg.2013.01.003

Cited by 112 publications

(86 citation statements)

References 5 publications

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“…Thus, we have preferred to define the adverse events as any event complicating patient progression, reserving the term "complication" for events that could unambiguously be attributed to the injury or the treatment itself through a statistically significant relationship. In the Ekeh et al studies (11,12), pleural effusion is reported as a complication of embolization in 17%-27% of cases. In the present study, the pleural effusion rate is independent of the management method but directly related to the severity of injury, notably to associated thoracic injury.…”

Section: Discussionmentioning

confidence: 97%

“…Indeed, in the literature assessing BSI management, some authors consider any adverse event occurring during hospitalization as a complication of this treatment Management of blunt splenic injury and early adverse events • 331 without any prior statistical relation being proven (11)(12)(13)28). Thus, we have preferred to define the adverse events as any event complicating patient progression, reserving the term "complication" for events that could unambiguously be attributed to the injury or the treatment itself through a statistically significant relationship.…”

Section: Discussionmentioning

confidence: 99%

“…The description and prevalence of these complications varies greatly from one series to another (7,(11)(12)(13), resulting from the confusion existing between adverse events related to injury and those related to treatment. The severity of polytrauma is taken into account using the patients' injury severity score (ISS), and several studies have shown that a high ISS was related to more nonsurgical treatment failures (14).…”

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confidence: 99%

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Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Frandon¹,

Rodière²,

Arvieux³

et al. 2015

Diagn Interv Radiol

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B lunt splenic injury (BSI) has become more frequently managed nonoperatively over the years, with the results improved by the contribution of embolization, making it possible to treat active hemorrhages as well as prevent hemorrhages in high-grade trauma of the spleen without active bleeding (1-10). Three methods of splenic artery injury management can be defined: operative management (OM), nonoperative management (NOM), and nonoperative management with splenic artery embolization (SAE).The complication rate in relation to different management methods (operative and nonoperative) continues to be debated. The description and prevalence of these complications varies greatly from one series to another (7,(11)(12)(13), resulting from the confusion existing between adverse events related to injury and those related to treatment. The severity of polytrauma is taken into account using the patients' injury severity score (ISS), and several studies have shown that a high ISS was related to more nonsurgical treatment failures (14). Certain authors have taken a specific interest in the parameters of multiple injuries and shown that lesions of associated organs (pancreas, spinal cord, limbs) were related to more complications (15-17). The severity of trauma and associated lesions could therefore be considered confounding factors resulting in treatment failure and complications. A better understanding of these complications could help in preventing them.The objectives of this study were to compare outcomes of the three types of BSI management, determine if there are any complications statistically related to management methods, and demonstrate risk factors taking polytrauma into account. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. RESULTSThe total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural drainage, acute renal failures, and pancreatitis in OM and more pseudocysts in SAE. Six prognostic factors were statistically significant for one or more adverse events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. CONCLUSIONPatients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Frandon¹,

Rodière²,

Arvieux³

et al. 2015

Diagn Interv Radiol

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“…They have reported rates ranging between 3 and 14 % [50,51]. A recent review over 1085 patients treated by NOM, 88 of whom submitted to angioembolization (AE), reports a complication rate of 14 % after AE.…”

Section: Nom Of the Spleen And Splenic Abscessesmentioning

confidence: 99%

“…A recent review over 1085 patients treated by NOM, 88 of whom submitted to angioembolization (AE), reports a complication rate of 14 % after AE. In particular, splenic infarction accounted for 2.3 % after AE, splenic abscess 6.8 %, contrast-induced renal insufficiency 2.3 %, and late development of splenic cyst 2.3 % [51]. Splenic infarction requires observation or surgery.…”

Section: Nom Of the Spleen And Splenic Abscessesmentioning

confidence: 99%

Management of Post-Traumatic Complications by Interventional Ultrasound: a Review

2016

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Purpose of Review We reviewed the current literature to assess the feasibility of ultrasound-assisted and ultrasoundguided procedures for the treatment of post-traumatic complications and to address the indications and techniques of procedures. Recent Findings Non-operative strategies have been introduced in the treatment of severe trauma, and consequently, the incidence of some post-traumatic complications has increased. US can be useful both for the initial assessment of trauma patients and for the treatment of complications. Summary Ultrasound-guided and ultrasound-assisted procedures as a therapeutic tool in the management of post-trauma settings are probably underused, in comparison with their successful use in other acute settings. Some new possible fields of clinical researches are suggested.

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Partial splenic embolization to permit continuation of systemic chemotherapy

Luz

Marchiori

et al. 2016

Cancer Medicine

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Systemic chemotherapy treatments, commonly those that comprise oxaliplatin, have been linked to the appearance of distinctive liver lesions that evolves to portal hypertension, spleen enlargement, platelets sequestration, and thrombocytopenia. This outcome can interrupt treatment or force dosage reduction, decreasing efficiency of cancer therapy. We conducted a prospective phase II study for the evaluation of partial splenic embolization in patients with thrombocytopenia that impeded systemic chemotherapy continuation. From August 2014 through July 2015, 33 patients underwent partial splenic embolization to increase platelets count and allow their return to treatment. Primary endpoint was the accomplishment of a thrombocyte level superior to 130 × 109/L and the secondary endpoints were the return to chemotherapy and toxicity. Partial splenic embolization was done 36 times in 33 patients. All patients presented gastrointestinal cancer and colorectal malignancy was the commonest primary site. An average of 6.4 cycles of chemotherapy was done before splenic embolization and the most common regimen was Folfox. Mean platelet count prior to embolization was 69 × 109/L. A total of 94% of patients achieved primary endpoint. All patients in need reinitiated treatment and median time to chemotherapy return was 14 days. No grade 3 or above adverse events were identified. Aiming for a 50% to 70% infarction area may be sufficient to achieve success without the complications associated with more extensive infarction. Combined with the better safety profile, partial splenic embolization is an excellent option in the management of thrombocytopenia, enabling the resumption of systemic chemotherapy with minimal procedure‐related morbidity.

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Complications arising from splenic artery embolization: a review of an 11-year experience

Cited by 112 publications

References 5 publications

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Management of Post-Traumatic Complications by Interventional Ultrasound: a Review

Partial splenic embolization to permit continuation of systemic chemotherapy

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