Background splenic artery embolization sae has been an effective adjunct to the nonoperative management nom for blunt splenic injury bsi. Endovascular treatment encompasses implantation of a coveredstent or coil embolization. The management for subcapsular splenic hematoma remains controversial. Large subcapsular splenic hematoma with a large pancreatic. The primary purpose of this study is to evaluate the safety and efficacy of partial splenic artery embolization in the treatment of symptomatic portal vein hypertension. Management of aneurysms involving branches of the celiac and superior mesenteric arteries. Combined embolization is defined by the combination of both techniques. For gelatin sponge embolization, when the splenic artery could be catheterized with a 4 or 5french catheter, gelatin sponge torpedoes were injected in rapid succession from a proximal splenic artery location. Also use of splenic embolization in patients with autoimmune hemolytic anemia was reported 5. Coil embolization of main splenic artery is not only more economical procedure than implantation of coveredstent, but also can relieve critical hypersplenism symptoms and easily treat the lesion located in the splenic hilum. The complications were caused by the partial splenic embolization procedure which had some leftover spleen that had to be fully removed. For distal splenic artery embolization, the microcatheter is placed as distally as possible in the injured splenic artery branches before embolization to preserve as much of the spleen as possible.
An alternative approach in a critically ill patient with autoimmune hemolytic anemia. Embolic suspension parenchymal phase angiograms to target splenic infarction of 50 haock ta wjr 2014. The splenic artery courses superior and anterior to the splenic vein, along the superior edge of the pancreas. Splenic embolization was rst introduced in, when autologous blood clot was used by maddison toproduce splenic artery embolization for hypersplenism treatment. Splenic artery aneurysms are the most common visceral artery aneurysms, with a reported prevalence of 0. For this purpose, a microcatheter is necessary, supported by a flexible and hydrophilic 4f catheter. To determine the impact of coil embolization of the splenic artery on splenic volume based on computed tomography ct imaging. Selective splenic artery embolization for the treatment of. The first large branch is the dorsal pancreatic artery, and the second large branch is the greater pancreatic artery or arteria pancreatica magna, which ari. Finally, multiple collateral routes of collateral perfusion combining any of the. The main splenic artery is then catheterized and a splenic arteriogram performed. A er sae, splenic ow was remarkably decreased figure d. Near the splenic hilum, the artery usually divides into superior and infe. Abdominal computed tomography act images were assessed for grade of splenic injury, volume of hemoperitoneum, and evidence of splenic vascular injury including splenic vascular lesions and active bleeding.
This study assessed preoperative splenic artery embolization before laparoscopic splenectomy. Sachdev u, baril dt, ellozy sh, lookstein ra, silverberg d, jacobs ts, carroccio a, teodorescu vj, marin m. If the splenic artery is long and winding, a triple coaxial catheterization may be required. Splenic and renal embolization amazon web services. Combining partial splenic embolization with ligation reduced the 6month variceal bleeding rate when compared with ligation alone from 58% to 21%, a result that. Most aneurysms are small dec 31, 2014 the purpose of this study was to report on splenic artery aneurysms saas treated by transcatheter embolization in our singlecenter institution and to evaluate the clinical outcomes of patients with saa by aneurysm location. We herein report a case of a large subcapsular splenic hematoma with a large pancreatic pseudocyst, which was successfully treated with splenic arterial embolization and ultrasound us guided percutaneous drainage of pancreatic pseudocyst, for the first. Partial splenic artery embolization for severe hepatic myelopathy in cirrhosis cyriac abby philips,1 lijesh kumar,2 and philip augustine3 hepatic myelopathy hm is a devastating but rare complication of cirrhosis and portal hypertension that profoundly affects quality of life and improves only with liver transplantation. Splenic artery embolization may be preferred over surgery when the aim is to preserve the immune functions of the spleen, for example, in traumatic injuries of the spleen minimal bleeding and maximal functional splenic tissue are sought. Comparison of total splenic artery embolization and partial splenic.
The spleen is the second most commonly injured organ in cases of abdominal trauma. Embolization for splenic trauma endovascular today. Partial splenic embolization microcatheter advanced into a distal segmental branch of the splenic artery. Management of splenic injury depends on the clinical status of the patient and can include nonoperative management nom. Absorbable gelatin upjohn, particles 300500 mm, or coils can be used either alone or in combination. We therefore sought to determine whether selective splenic artery embolization ssae is a safe and effective alternative to splenectomy for tst in patients with pnh. Majercik, md, jeff jednacz, md, robert lambiase, md, and william g. Proximal splenic artery embolization in blunt splenic injuries is a welltolerated technique without major longterm impact on the splenic anatomy and immune function. Splenic artery embolization for massive splenomegaly. However, no consensus has been reached on the correct indications for combining nom and sae, especially in higher grade splenic injuries. Other branches of splenic artery were not considered in the. Splenic embolization procedure answers on healthtap.
Boston scientific, natick, ma are placed as distally and near to the injured vessel as possible. Transcatheter splenic artery embolization has a major role in the management of traumatic splenic injuries and as an adjunctive procedure in the treatment of thrombocytopenia and portal hypertension. Transcatheter arterial embolization of splenic artery. Celiac and splenic arteriography revealed no active bleeding from arterial system figures a b. A secondary aim is to evaluate the relative efficacy of two separate splenic artery embolization techniques, coiling versus particle embolization of the spleen. Dualinterventional therapy for multiple splenic artery. Partial splenic artery embolization in cirrhotic patients. Partial splenic artery embolization for severe hepatic.
Thirteen patients 9 men and 4 women with a mean age of 56 years range 2270 who developed splenic artery syndrome after olt with decreased liver perfusion and clinically relevant impairment of liver function increased transaminase or serum bilirubin levels, thrombocytopenia, andor therapyrefractory ascites were treated by embolization of the proximal third of. Splenic artery aneurysms are rare, but still the third most common abdominal aneurysm, after aneurysms of the abdominal aorta and iliac arteries. Has anyone any knowledge of what to expect after splenic. Under suspicion of bleeding gvs, sae was performed using vascular plug figure c. Two additional patients developed splenic atrophy diagnosed on ct scanning after previous embolization of the splenic artery, without clear clinical evidence of initial splenic infarction. To evaluate whether total splenic artery embolization tsae for patients with hypersplenism delivers better longterm outcomes than partial splenic. Splenic embolization for portal hypertension full text view. The increased susceptibility of patients to infections after splenectomy has led to the use of splenic preservation procedures 4, 5. Preoperative splenic artery embolization was used in 26 of 54 patients 48% undergoing laparoscopic splenectomy.
A splenic artery embolization can be performed before the surgery, in order to decrease both the size of the spleen and the risk of bleeding. The surgeon planned for lacroscopic splenectomy, but there were some complications, so woke up with open splenectomy being done. Review article clinical application of partial splenic. When the splenic artery could not be catheterized with the 4 or 5french. The catheter can be further supported with sheaths such as the destination sheath terumo interventional systems, somerset, nj, which can be placed in the celiac or proximal splenic artery. Seven years later, transcatheter partial splenic embolization pse was developed by spigos et al. If a distal embolization procedure is to be performed, a microcatheter and wire combination e. Splenic artery embolization sae, in a patient with. Review of proximal splenic artery embolization in blunt abdominal. The favourable outcome of our patient depicts a pivotal role of preoperative splenic artery embolization in haemodynamically compromised patients undergoing cardiac valvular surgery for ie. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Advantages of single port surgery are mostly cosmetic.
Sep, 2016 the spleen is the second most commonly injured organ in cases of abdominal trauma. Whether arteriosclerosis is the cause of the aneurysm or is a secondary phenomenon is. Splenic haematoma complicating infective endocarditis. It was first described in 1981 by sclafani 3 and became more widely used in the late 1990s. Management of splenic injury depends on the clinical status of the patient and can include nonoperative management nom, splenic artery embolization sae, surgery operative splenic salvage or splenectomy, or a combination of these treatments. Under aseptic technique, the splenic artery was selectively cannulated via the transfemoral route, and partial embolization was achieved using gel foam pledgets, resulting in a decrease in 50% of parenchymal staining. Splenic artery angioembolization embo has been promoted to increase the success rate of nonoperative management of splenic injuries. Outcomes of proximal versus distal and combined splenic artery. Proximal embolization is defined by introduction of the embolization material into the splenic artery trunk and distal embolization by embolizing a segmental branch in the intraparenchymal portion of the organ.
Splenic artery embolization as an adjunctive procedure for portal. Subcapsular splenic hematoma is a rare complication of pancreatitis. The embolization of intraparenchymal arterial bleeding needs to reach small peripheral arteries. Splenic artery embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. In another study, one episode of splenic infarction associated with sever pancreatitis was noted after embolization of a distal splenic artery aneurysm. Splenic artery embolization before laparoscopic splenectomy. In nonoperatively managed cases, sae is sometimes used to control. Here, we report the case of a 56yearold man diagnosed with massive splenomegaly, secondary to a marginal splenic lymphoma, which had a maximum diameter of 54 cm. From the department of radiology and interventional radiology, hopital bicetre, rue du general leclerc, 94 le kremlinbicetre, france. Role of splenic artery partial embolization in a patient with. Sep 05, 20 has anyone any knowledge of what to expect after splenic artery embolization.
Partial splenic artery embolization pse has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. Single port surgery uses a special port that multiple instruments go through, unlike traditional laparoscopy where each port canfield only one instrument. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm group i, except the first two 1820. Pdf abstract the spleen is the most commonly injured organ in blunt abdominal. Splenic arteriography was performed for highgrade splenic injury and for act evidence of vascular injury. They may occur in pregnant women in the third trimester and rupture carries a maternal mortality of greater than 50% and a fetal mortality of 7090%. Proximal splenic artery embolization decreases the perfusion. Proximal splenic artery embolization for blunt splenic injur.
Experience with splenic main coil embolization and. The splenic artery has many branches that supply the pancreatic body and tail. Splenic vascular anatomy the splenic artery supplies the spleen and substantial portions of the stomach and pancreas fig 1 1. Case report splenic artery embolization for the treatment of. Our institutional clinical pathway calls for embo in the setting of ongoing splenic bleeding or contrast blush on computed tomography scan. Preoperative splenic artery embolization was successfully performed and the patient subsequently received lifesaving cardiac valvular replacement surgery. To note type of branching pattern of the splenic artery and occurrence of polar artery. Splenic artery aneurysms occur more frequently in women and are associated with pregnancy and multiparity.
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