The role of arterial embolization in blunt splenic injury

Monaco, D.; Franco, Fernanda Lorenzo; Marcato, Carla; Larini, P; Rossi, Cristina; Volpi, Annalisa

doi:10.1007/s11547-011-0624-y

Cited by 23 publications

(21 citation statements)

References 25 publications

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“…Of the 44 studies, 12 were excluded without follow-up [1, 12, 15, 17, 20–23, 37–40], and 9 studies were excluded because of the lack of detailed data about SAE techniques [19, 29, 31, 41–46]. Finally, 23 relevant studies [7, 10, 11, 16, 25–28, 30, 32, 47–59] were included as 1st study set. Then, 13 studies in 1st study set were excluded with significant differences of grades of AAST-OIS and the remaining 10 studies were included in 2nd study set (Flow diagram shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The average age in included studies was 38.8 ± 5.4 years (range 16–89) and most of the patients were male (72.4%, range 57.9–92.9%). The contrast blush (38.4%) or pseudoaneurysm (8.2%), high-grade (AAST III-V) splenic injury (50.1%), and large hemoperitoneum (18.0%) were widely considered as major indications for embolization after splenic injury [4, 7, 10, 11, 25–27, 30, 32, 47–51, 53–55, 57]. More than one indication per patient could occur and the distribution of these individual indications for embolization differed significantly in studies (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Embolization may be performed proximal (main splenic artery), distal (small arterial branches within the splenic parenchyma), or combination. Several researches over the past few years have reported conflicting clinical outcomes of different embolization locations [7, 10, 11, 23, 25–28, 32, 48, 53, 56, 57]. Proximal SAE achieves hemostasis by reducing pulse pressure and decreasing the distal flow of the splenic parenchyma.…”

Section: Discussionmentioning

confidence: 99%

“…Data including the first author, publication year, number of patients, age, gender, indications for embolization, grades of American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS), locations of embolization, embolic materials were extracted from studies, as well as the clinical outcomes including the number of successfully treated patients, severe complications which were life-threatening (rebleeding, infarction, abscess, cyst and contrast-induced renal insufficiency) and Dindo-Clavien classification of morbidity for complication III (DC III, see Table 1) which need further surgical management after SAE [7, 11, 15, 25, 26, 28–32]. …”

Section: Methodsmentioning

confidence: 99%

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The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

et al. 2017

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BackgroundSplenic artery embolization (SAE) has been an effective adjunct to the Non-operative management (NOM) for blunt splenic injury (BSI). However, the optimal embolization techniques are still inconclusive. To further understand the roles of different embolization locations and embolic materials in SAE, we conducted this system review and meta-analyses.MethodsClinical studies related to SAE for adult patients were researched in electronic databases, included PubMed, Embase, ScienceDirect and Google Scholar Search (between October 1991 and March 2013), and relevant information was extracted. To eliminate the heterogeneity, a sensitivity analysis was conducted on two reduced study sets. Then, the pooled outcomes were compared and the quality assessments were performed using Newcastle-Ottawa Scale (NOS). The SAE success rate, incidences of life-threatening complications of different embolization techniques were compared by χ 2 test in 1st study set. Associations between different embolization techniques and clinical outcomes were evaluated by fixed-effects model in 2nd study set.ResultsTwenty-three studies were included in 1st study set. And then, 13 of them were excluded, because lack of the necessary details of SAE. The remaining 10 studies comprised 2nd study set, and quality assessments were performed using NOS. In 1st set, the primary success rate is 90.1% and the incidence of life-threatening complications is 20.4%, though the cases which required surgical intervention are very few (6.4%). For different embolization locations, there was no obvious association between primary success rate and embolization location in both 1st and 2nd study sets (P > 0.05). But in 2nd study set, it indicated that proximal embolization reduced severe complications and complications needed surgical management. As for the embolic materials, the success rate between coil and gelfoam is not significant. However, coil is associated with a lower risk of life-threatening complications, as well as less complications requiring surgical management.ConclusionsDifferent embolization techniques affect the clinical outcomes of SAE. The proximal embolization is the best option due to the less life-threatening complications. For commonly embolic material, coil is superior to gelfoam for fewer severe complications and less further surgery management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

et al. 2017

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“…Although arterial embolization has been widely applied in patients with closed abdominal injuries [15],[16],[22], surgery is still a main choice to stop the bleeding caused by open abdominal injury. There is a lack of study focusing on on-spot emergent interventional embolization treatment of open abdominal injury.…”

Section: Discussionmentioning

confidence: 99%

Emergency treatment of splenic injury in a novel mobile minimally invasive interventional shelter following disaster: a feasibility study

Tian-ming

Rong

Liang

et al. 2014

Scand J Trauma Resusc Emerg Med

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BackgroundThere has been an increase in natural disasters in recent years, which leads to a great number of injuries and deaths. It still remains an unsolved problem to treat patients with vascular injury of solid organs effectively following natural disasters, but on-spot emergency interventional transcatheter arterial embolization (TAE) has been highly recommended to cure serious vascular injury of solid organs nowadays. Spleen is the most vulnerable abdominal organ, severe arterial hemorrhage of which can cause death if untreated timely. In this research, we aimed to study the possibility of performing emergency surgical intervention in mobile minimally invasive interventional shelter for splenic injury in the case of natural disasters.MethodsFirst, the mobile minimally invasive interventional shelter was unfolded in the field, and then disinfection and preoperative preparation were performed immediately. Eight large animal models of splenic injury were created, and angiograms were performed using a digital subtraction angiography machine in the mobile minimally invasive interventional shelter, and then the hemostatic embolizations of injured splenic artery were performed following the established convention of rapid intervention therapy. The operating time was recorded, and the survival condition and postoperative complications were observed for two weeks.Results and discussionThe average time of unfolding the shelter, and performing disinfection and preoperative preparation was 33 ± 7 min. The number of colonies in the sterilized shelter body was 86 ± 13 cfu/m3. The average TAE time was 31 ± 7 min. All the hemostatic embolizations of splenic injury were performed successfully in the mobile minimally invasive interventional shelter during the operation. A pseudoaneurysm was found in an animal model using angiography two weeks after the operation. The primary clinical success rate of embolization was 87.5%. The two-week survival rate in all animal models of splenic injury was 100%.ConclusionsOur findings in the current study demonstrate that the mobile minimally invasive interventional shelter can be adapted to the field perfectly and complete emergency surgical intervention for splenic injury efficiently and safely. Therefore, on-spot emergency interventional TAE for vascular injury of solid organs (e.g. spleen) in mobile minimally invasive interventional shelter is available and effective.

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Splenic Injuries

D’Amico¹,

Cozzi²,

Verrone³

et al. 2017

Diagnostic Imaging in Polytrauma Patients

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The role of arterial embolization in blunt splenic injury

Abstract: On the basis of our algorithm, it is possible to reach a quick decision on the most appropriate treatment for patients presenting with blunt abdominal trauma, and splenic artery embolization seems to offer a reliable option in those with high-grade splenic injury or active bleeding.

Cited by 23 publications

References 25 publications

The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

Emergency treatment of splenic injury in a novel mobile minimally invasive interventional shelter following disaster: a feasibility study

Splenic Injuries

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