Refining the role of splenic angiographic embolization in high-grade splenic injuries

Skattum, Jorunn; Næss, Paal Aksel; Eken, Torsten; Gaarder, Christine

doi:10.1097/ta.0b013e31827890b2

Cited by 65 publications

(53 citation statements)

References 16 publications

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“…Furthermore, we did look for other complications associated with AE such as pseudoaneurysm at the catheter site. [1213] There was not statistical significance for any of the above complications; however, the 90% of the patients had no complications from undergoing either AE or angiographic evaluation. In addition to size and volume of the IVCE, information such as time to angiography, admitting hemoglobin, transfusion requirement, age, gender were compared and there were no statistical significance for those who underwent AE and does who did not.…”

Section: Discussionmentioning

confidence: 90%

Angioembolization is necessary with any volume of contrast extravasation in blunt trauma

Bhakta

Magee

Peterson

et al. 2017

Int J Crit Illn Inj Sci

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Introduction:Reduction of nonessential angiogram and embolization for patients sustaining blunt abdominal and pelvic trauma would allow improved utilization and decreased morbidity related to nontherapeutic embolization. We hypothesized that the nature of intravenous contrast extravasation (IVCE) on computed tomography (CT) would be directly related to the finding of extravasation on angiogram and need for embolization.Methods:A 5-year retrospective evaluation of trauma patients with IVCE on CT. Demographics, hemodynamics, and IVCE location and maximal dimension/volume were examined for relationship to IVCE on angiography and need for embolization. Primary complications were defined as nephropathy and acute respiratory distress syndrome.Results:A total of 128 patients were identified with IVCE on CT. Ninety-seven (75.8%) also had IVCE identified on angiography requiring some form of embolization. The size of IVCE on CT was not related to IVCE on angiogram (P = 0.69). Location of IVCE was related to need for embolization, with spleen embolization (85.4%) being much more frequent than liver (51.5%, P = 0.006). Complication rate was 8.7% in all patients, and was not different between patients undergoing embolization and those who did not (P = 0.40).Conclusion:IVCE volume was not predictive of continued bleeding and need for embolization. However, splenic injuries with IVCE required embolization more frequently. In contrast, liver injuries were found to have infrequent on-going IVCE on angiography. Complications associated with angiogram with or without embolization are infrequent, and CT findings may not be predictive of ongoing bleeding. We do not recommend selective exclusion of patients from angiographic evaluation when a blush is present.

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Section: Discussionmentioning

confidence: 90%

Angioembolization is necessary with any volume of contrast extravasation in blunt trauma

Bhakta

Magee

Peterson

et al. 2017

Int J Crit Illn Inj Sci

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“…En effet, la mortalité au décours de traumatisme splénique est le plus souvent en rapport avec les lésions associées [9]. En effet, la mortalité au décours de traumatisme splénique est le plus souvent en rapport avec les lésions associées [9].…”

Section: Resultsunclassified

Le traitement non opératoire des traumatismes spléniques sévères fermés est-il le moins morbide ? Résultats d’une étude prospective multicentrique

Chastang

Bège

Prudhomme

et al. 2015

Journal de Chirurgie Viscérale

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“…While surgery is often considered the definitive treatment for bleeding control, it may not always be the optimal solution for stabilization of a polytrauma patient. Specifically, arterial hemorrhage arising from pelvic fractures [2-10] and solid organ injuries [11-18] are amenable to management with angiography and embolization.…”

Section: Introductionmentioning

confidence: 99%

“…While there is no such recommendation for renal and splenic injuries, several studies have demonstrated a valuable role for angiography and embolization in these setting [18, 21-26]. In addition, there has been a trend toward watchful management of these injuries by trauma centers [27].…”

Section: Introductionmentioning

confidence: 99%

Utilization of Angiography and Embolization for Abdominopelvic Trauma: 14 Years’ Experience at a Level I Trauma Center

Roudsari

Psoter

Padia

et al. 2014

American Journal of Roentgenology

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Purpose To evaluate the long-term trends in the use of angiography and embolization for abdominopelvic injuries. Methods Utilization rates for pelvic and abdominal angiography, arterial embolization, and computed tomography (CT) were analyzed for trauma patients with pelvic fractures, liver and kidney injuries admitted to a level I trauma center from 1996-2010. Multivariable linear regression was used to evaluate trends in the use of angioembolization. Results A total of 9,145 patients were admitted for abdominopelvic injuries. Pelvic angiography decreased annually by 5.0% (95%CI: −6.4,−3.7%) from 1996-2002 and by 1.8% (95%CI: −2.4,−1.2%) from 2003-2010. Embolization rates for these patients varied from 49% in 1997 to 100% in 2010. Utilization of pelvic CT on the day of admission increased significantly during this period. Abdominal angiography for liver and kidney injuries decreased annually by 3.3% (95%CI: −4.8,−1.8%) and 2.0% (95%CI: −4.3,0.3%) between 1996-2002 and by 0.8% (95%CI: −1.4,−0.1%) and 0.9% (95%CI: −2.0,0.1) from 2003-2010, respectively. Embolization rates ranged from 25% in 1999 to 100% in 2010 for liver injuries and from 0% in 1997 to 80% in 2002 for kidney injuries. Abdominal CT for liver and kidney injuries on the day of admission also increased. Conclusions A significant decrease in angiography use for trauma patients with pelvic fractures, liver and kidney injuries from 1996-2010 and a trend toward increasing embolization rates among patients who underwent angiography was found. These findings reflect a declining role of angiography for diagnostic purposes, while emphasizing the importance of angiography as a means to embolization for management.

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Refining the role of splenic angiographic embolization in high-grade splenic injuries

Abstract: Therapeutic study, level IV.

Cited by 65 publications

References 16 publications

Angioembolization is necessary with any volume of contrast extravasation in blunt trauma

Angioembolization is necessary with any volume of contrast extravasation in blunt trauma

Le traitement non opératoire des traumatismes spléniques sévères fermés est-il le moins morbide ? Résultats d’une étude prospective multicentrique

Utilization of Angiography and Embolization for Abdominopelvic Trauma: 14 Years’ Experience at a Level I Trauma Center

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