Therapeutic strategies for pseudoaneurysm following blunt liver and spleen injuries: a multicenter cohort study in the pediatric population.

Abstract

BACKGROUND:Little guidance exists for the treatment of pseudoaneurysm (PA) following pediatric blunt liver and/or spleen injuries (BLSIs). We aimed to describe the incidence of delayed PA development and the subsequent clinical course of PA in pediatric BLSIs. METHODS:This multicenter retrospective cohort study from Japan included pediatric patients (16 years and younger) who sustained BLSIs from 2008 to 2019. The cohort was divided into four groups based on hemostatic intervention within 48 hours of admission, namely, nonoperative management (NOM), NOM with interventional radiology (IR), operative management (OM), and combined IR/OM. Descriptive statistics were used to describe the incidence of delayed PA among the groups and to characterize the clinical course of any PAs. RESULTS:A total of 1,407 children (median age, 9 years) from 83 institutions were included. The overall number (incidence) of cases of delayed PA formation was 80 (5.7%), and the number with delayed PA rupture was 16 cases (1.1%) in the entire cohort. Patients treated with NOM (1,056), NOM with IR (276), OM (53), and combined IR/OM (22) developed 43 (4.1%), 32 (12%), 2 (3.8%), and 3 (14%) delayed PAs, respectively. Among patients who developed any PAs, 39% of patients underwent prophylactic IR for unruptured PA, while 13% required emergency angioembolization for delayed PA rupture, with one ruptured case requiring total splenectomy. At least 45% of patients experienced spontaneous resolution of PA without any interventions. CONCLUSION:Our results suggest that the risk of delayed PA still exists even after acute phase IR as an adjunct to NOM for BLSIs in children, indicating the necessity of a period of further observation. While endovascular interventions are usually successful for PA management, including rupture cases, given the high incidence of spontaneous resolution, the ideal management of PA remains to be investigated in future studies.

Incidence of pseudoaneurysm after follow‐up computed tomography for nonoperatively managed splenic injury: Systematic review

“…The estimated incidences of PSA were confirmed to be similar in NOM patients regardless of whether initial SAE was performed, in contrast to our hypothesis. A recent multicenter study involving pediatric liver and splenic injuries reported similar results, indicating that delayed PSA existed even after initial SAE (12%, 32/276) 21 . One possible reason is that patients managed with initial SAE were more likely to have complex and severe injuries, including vascular injuires that could potentially remain undetected in the acute post‐injury phase.…”

“…A recent multicenter study involving pediatric liver and splenic injuries reported similar results, indicating that delayed PSA existed even after initial SAE (12%, 32/ 276). 21 One possible reason is that patients managed with initial SAE were more likely to have complex and severe injuries, including vascular injuires that could potentially remain undetected in the acute post-injury phase. Another contributing factor could be inadequate reduction in blood flow related to SAE techniques.…”