Jay Anthony Requarth1, Preston R Miller. 1. Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina 27106, USA. requarth@wakehealth.edu
Abstract
BACKGROUND: Proximal splenic artery embolotherapy can be used as an adjunct to nonoperative management of blunt splenic injury (BSI); however, the hemodynamic changes in the distal splenic artery after proximal splenic artery occlusion are unknown. METHODS: A retrospective review of 48 patients who underwent transient occlusion of the proximal splenic artery with distal splenic artery pressure measurements was performed. Patients were grouped into those with celiac artery stenosis and those with normal celiac anatomy as determined by contrast-enhanced computed tomography. RESULTS: Celiac stenosis was identified in 12 (25.0%) of the 48 patients. The celiac stenosis and normal anatomy groups were not statistically different in their systolic pressure, diastolic pressure, mean arterial pressure, age, sex, and splenic injury grade. Transient occlusion of the proximal splenic artery resulted in a decreased distal splenic artery systolic pressure, diastolic pressure, and mean arterial pressure and a decreased systolic and mean perfusion gradient in all patients (42.6 ± 20.8 mm Hg, 39.7 ± 17.8 mm Hg, 40.9 ± 18.9 mm Hg, 67.4 ± 14.5%, and 55.4 ± 17.9%, respectively). The distal splenic artery stump pressure values in the celiac stenosis and normal anatomy patients differed significantly (72.7 ± 32.0 mm Hg vs. 36.7 ± 11.2 mm Hg, 66.6 ± 26.5 mm Hg vs. 34.4 ± 9.3 mm Hg, 69.0 ± 27.9 mm Hg vs. 35.5 ± 10.2 mm Hg, 46.1 ± 19.7% vs. 71.6 ± 8.9%, 28.8 ± 21.6% vs. 60.6 ± 11.7%, for systolic pressure, diastolic pressure, mean arterial pressure, systolic gradient, and mean gradient in celiac stenosis and normal anatomy BSI patients, respectively; all values of p < 0.0001). CONCLUSION: In hemodynamically stable BSI patients, the systolic pressure in the distal splenic artery is decreased by an average of 67% after proximal splenic artery embolotherapy; however, the pressure reduction in those patients with celiac stenosis is significantly less. This finding may explain some postembolotherapy delayed splenic hemorrhage events. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III; therapeutic study, level IV.
BACKGROUND: Proximal splenic artery embolotherapy can be used as an adjunct to nonoperative management of blunt splenic injury (BSI); however, the hemodynamic changes in the distal splenic artery after proximal splenic artery occlusion are unknown. METHODS: A retrospective review of 48 patients who underwent transient occlusion of the proximal splenic artery with distal splenic artery pressure measurements was performed. Patients were grouped into those with celiac artery stenosis and those with normal celiac anatomy as determined by contrast-enhanced computed tomography. RESULTS:Celiac stenosis was identified in 12 (25.0%) of the 48 patients. The celiac stenosis and normal anatomy groups were not statistically different in their systolic pressure, diastolic pressure, mean arterial pressure, age, sex, and splenic injury grade. Transient occlusion of the proximal splenic artery resulted in a decreased distal splenic artery systolic pressure, diastolic pressure, and mean arterial pressure and a decreased systolic and mean perfusion gradient in all patients (42.6 ± 20.8 mm Hg, 39.7 ± 17.8 mm Hg, 40.9 ± 18.9 mm Hg, 67.4 ± 14.5%, and 55.4 ± 17.9%, respectively). The distal splenic artery stump pressure values in the celiac stenosis and normal anatomy patients differed significantly (72.7 ± 32.0 mm Hg vs. 36.7 ± 11.2 mm Hg, 66.6 ± 26.5 mm Hg vs. 34.4 ± 9.3 mm Hg, 69.0 ± 27.9 mm Hg vs. 35.5 ± 10.2 mm Hg, 46.1 ± 19.7% vs. 71.6 ± 8.9%, 28.8 ± 21.6% vs. 60.6 ± 11.7%, for systolic pressure, diastolic pressure, mean arterial pressure, systolic gradient, and mean gradient in celiac stenosis and normal anatomy BSI patients, respectively; all values of p < 0.0001). CONCLUSION: In hemodynamically stable BSI patients, the systolic pressure in the distal splenic artery is decreased by an average of 67% after proximal splenic artery embolotherapy; however, the pressure reduction in those patients with celiac stenosis is significantly less. This finding may explain some postembolotherapy delayed splenic hemorrhage events. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III; therapeutic study, level IV.
Authors: Jing-Jing Rong; Dan Liu; Ming Liang; Qing-Hua Wang; Jing-Yang Sun; Quan-Yu Zhang; Cheng-Fei Peng; Feng-Qi Xuan; Li-Jun Zhao; Xiao-Xiang Tian; Ya-Ling Han Journal: Mil Med Res Date: 2017-05-30