Splenic artery embolization for the treatment of gastric. Pdf utility of the amplatzer vascular plug in splenic. Proximal splenic artery embolization blocks the splenic artery inflow to the spleen, thus, decreases the risk of intraoperative arterial bleeding. Herein, we report a case of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis successfully treated with splenic artery embolization. Pdf on jan 27, 2017, marcello di martino and others published splenic artery embolization for massive splenomegaly find, read and cite all the research. The increased susceptibility of patients to infections after splenectomy has led to the use of splenic preservation procedures 4, 5. The most frequent complication observed was splenic infarction, being. Splenic artery aneurysms are the most common visceral artery aneurysms, with a reported prevalence of 0.
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. For procedure planning, celiac and splenic artery anatomy should be evaluated on contrastenhanced ct images, including two and threedimensional formats, to help determine a vascular access route and choose adequate materials for either proximal or distal splenic artery embolization. Splenic trauma can also be treated by embolization of the splenic artery. This study was performed to investigate the efficacy of proximal splenic artery embolization using detachable balloons for patients with hypersplenism and portal hypertension. It was first described in 1981 by sclafani 3 and became more widely used in the late 1990s. Review of proximal splenic artery embolization in blunt. Splenic artery aneurysms are the most common visceral artery aneurysms.
Splenic artery embolization sae is increasingly being used as a nonoperative management strategy for patients with blunt splenic injury following trauma. Embolization for splenic trauma endovascular today. Splenic artery angioembolization embo has been promoted to increase the success rate of nonoperative management of splenic injuries. Salient points for each vaa are summarized in table 1410 and case examples are shown in figures 1 and 2. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. 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. When the splenic artery could not be catheterized with the 4 or 5french catheters owing to vessel tortuosity or stenosis at the origin of the celiac artery, or if distal embolization was intended, a 2 to 2. Splenic artery aneurysms away from the hilum can be excluded with a stent graft. Case report splenic artery embolization for the treatment of. The splenic artery or lienal artery is the blood vessel that supplies oxygenated blood to the spleen. Boston scientific, natick, ma are placed as distally and near to the injured vessel as possible. A comparison study with conventional coil technique. A clinical study was performed, with splenic function assessed by examining the antibody response to polysaccharide antigens pneumococcal 23valent. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm group i, except the first two 1820.
It branches from the celiac artery, and follows a course superior to the pancreas. Splenic artery syndrome is a poorly understood phenomenon with no current consensus on clinical diagnosis criteria. Maddison 3 reported a successful medical splenectomy in a patient who underwent selective splenic arterial embolization. Recently, splenic artery embolization sae has been described as an effective procedure for reducing portal hyperperfusion in patients undergoing partial or whole liver transplantation. Splenic embolization for a giant splenic hemangioma in a. If a distal embolization procedure is to be performed, a microcatheter and wire combination e. Utility of the amplatzer vascular plug in splenic artery embolization. Pdf splenic liquefaction after splenic artery embolization. The aim of this study was to assess the splenic function of patients who were embolized. Splenic artery embolization, which potentially preserves splenic function, was reported in a few cases.
Since the introduction of major trauma centres and regional trauma networks in 2012, management of splenic injury has shifted, with nonoperative management now favoured. Following embolization, angiography demonstrated complete occlusion of the splenic artery fig. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained via collateral pathways. In this patient population, partial splenic embolization can decrease the incidence of variceal bleeding, and protection can persist for at least a year. Splenic artery embolization has been used as an adjunct to nonsurgical treatment of blunt splenic injuries. Distal embolization can be used in cases of focal injury. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained.
However, if the celiac trunk is horizontal and the splenic artery is tortuous, reaching the middle part of the splenic artery with a sheath or a guiding catheter may be difficult. Surgery of trauma aast grades iii to v splenic injuries and those demonstrated to have vascular injuries. Splenic artery definition of splenic artery by the free. Splenic artery embolization before laparoscopic splenectomy. Third, the risk of parenchymal bleeding during surgical dissection may be increased due to the size of the spleen and intrasplenic vascular malformation involvement. Mar 27, 2014 splenectomy could alleviate thrombocytopenia and reduce portal pressure, but it can cause postoperative thromboses and opportunistic infections. All these patients underwent sae in other hospitals. Transcatheter embolization of a splenic artery aneurysm. Embolization of a giant splenic artery aneurysm insight. Most aneurysms are small splenic artery steal syndrome with the advantage of radiologic intervention to embolize the splenic artery and improve the hepatic arterial inflow. Use of splenic artery embolization as an adjunct to nonsurgical. We analyzed their clinical symptoms, treatments and prognoses. Two widely used embolization approaches are proximal and distal splenic artery embolization. Antibody response to a tcellindependent antigen is.
An alternative approach in a critically ill patient with autoimmune hemolytic anemia. The patients did not receive total but only partial embolization of splenic artery, with the splenic embolization volume ranging from 50% to 70%. Splenic artery embolization for the treatment of refractory. Embolization to occlude ruptured peripheral aneurysms with hemorrhage superior mesenteric artery inferior mesenteric artery gastroduodenal artery splenic artery renal artery hepatic artery internal iliac hypogastric artery embolization to occlude vessels with hemorrhage due to trauma or vessel injury. Preservation of splenic tissue with a reduced risk of repeated hemorrhage can be obtained with proximal splenic artery embolization. In hemodynamically unstable patients, splenectomy is the definitive management. In prior decades, splenic arterial embolization sae was used increasingly in the setting of nonoperative management of blunt splenic trauma. Complications arising from splenic artery embolization. The main splenic artery is then catheterized and a splenic arteriogram performed. Preoperative splenic artery embolization in klippel. Trauma center variation in splenic artery embolization and. Braun, sempach, switzerland was additionally used for more complete embolization.
Embolization that occurred distal to the main splenic artery trunk was considered to be distal. Here we describe our experience with sae for the treatment of ra. Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for. Embolization treatment for splenic artery aneurysms. Mar 18, 2019 two widely used embolization approaches are proximal and distal splenic artery embolization. Chung and reuter 2 embolized the splenic artery in dogs and found the spleen to be shrunken and fibrosed at 8 weeks. The splenic artery has many branches that supply the pancreatic body and tail. Embolization of the entire splenic artery, if selective catheterization of the aneurysm cannot be performed, is an alternative option. Nonoperative management was carried out successfully in 22% of patients who sustained a spleen injury after colonoscopy. Completion arteriography was performed from the proximal main splenic artery to ensure cessation of flow and absence of additional injury. Splenic arterial interventions rsna publications online. The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm.
Nov 17, 2016 splenic artery embolization is a safe and effective alternative to surgical splenectomy, especially in patients who are poor surgical candidates due to associated comorbidities. Majercik, md, jeff jednacz, md, robert lambiase, md, and william g. Splenic artery embolization for nonsurgical splenectomy. Review of proximal splenic artery embolization in blunt abdominal. Emoliation endovascular management of visceral artery. For those requiring intervention, splenic artery embolisation is well established as a firstline treatment in all but the most severely injured. Proximal splenic artery embolization in the management of sp. Splenic artery embolization diagnostic and interventional radiology. Necrosis of the tail of pancreas following proximal splenic. 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. Following introduction of regional trauma networks, the use of splenic artery embolization for management of blunt splenic injury increased from 3. Proximal splenic artery embolization in children may be a safe therapeutic alternative to either conservative or surgical management in spontaneous splenic rupture.
Most are small less than 2 cm, saccular aneurysms, and more than 80% are located in the mid or distal splenic artery. Selective splenic artery embolization for the treatment of. The clinical data of the patients are shown in table 1. In patients with hilar aneurysms, such as the one presented, coil embolization is a viable option. Cureus grade iii spleen laceration after a colonoscopy. Splenic artery embolization sae is an accepted nonsurgical inter vention for the treatment of a variety of clinical disorders 1. This study assessed preoperative splenic artery embolization before laparoscopic splenectomy. Pdf splenic artery embolization for massive splenomegaly. While splenic artery embolization is increasing in frequency, more investigators have reported complications associated with embolization techniques. We occluded the splenic artery at the distal level.
Splenic artery embolization as an adjunctive procedure for portal. Splenic artery aneurysms saas constitute the highest percentage of vaas at 60%, renal artery aneurysms raas are the second common type of vaa, and hepatic artery aneurysms haas are the most symptomatic. Splenic embolization in hypersplenic thrombocytopenia. The splenic artery gives off branches to the stomach and pancreas before reaching the spleen. It is an especially useful for the treatment of variceal bleeding due to hepatic cirrhosis. Splenic artery embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. Splenic artery embolization could be the best treatment option for gastric variceal bleeding when splenectomy is difficult such as in case associated with. Severe complications after splenic artery embolization for. Transcatheter coil embolization of splenic artery aneurysm.
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