Osnat Zmora1, Yitzhak Kori2, David Samuels2, Ada Kessler3, Carl I Schulman4, Joseph M Klausner5, Dror Soffer6,7. 1. General Surgery Division of Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel. 2. Unit of Angiography, Division of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel. 3. Unit of Ultrasonography, Division of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel. 4. Division of Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel. 5. Divisions of Burns, Trauma and Critical Care, University of Miami Faculty of Medicine, Miami, Florida, USA. 6. The Yitzhak Rabin Trauma Center, Division of Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel. sofferdror@hotmail.com. 7. The Yitzhak Rabin Trauma Center, Division of Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, 6 Weizman St, 64239, Tel-Aviv, Israel. sofferdror@hotmail.com.
Abstract
BACKGROUND: Proximal embolization of the splenic artery (PSAE) has recently been reported for traumatic splenic injury. The suggested mechanism of action entails a decrease in the splenic blood pressure without ischemia due to collateral blood supply. The main complications of selective embolization are continuous bleeding, splenic infarcts and splenic abscesses. The main complications of observation alone are continuous bleeding and formation of splenic pseudoaneurysms. Our aim was to assess the efficacy of PSAE in the cessation of bleeding without formation of pseudoaneurysms, and the outcome of the spleen after such intervention. METHODS: A prospective observational study of all patients undergoing PSAE for traumatic splenic injury in our institution over a 33-month period. Clinical and Doppler sonographic examinations were performed to assess cessation of bleeding, splenic blood flow, and formation of splenic pseudoaneurysms, infarcts or abscesses. RESULTS: During 33 months, 11 patients with blunt abdominal trauma and tomographic evidence of either high grade or actively bleeding splenic injuries were treated by PSAE. During follow-up, no patient underwent surgery or repeated embolization. Preserved blood flow was found on Doppler sonography in 82% of the patients and no pseudoaneurysms were demonstrated. A perisplenic collection was found in one patient and responded well to percutaneous drainage. CONCLUSIONS: Proximal embolization of the splenic artery for severe splenic injury is highly successful in cessation of bleeding while preserving splenic architecture. There were minimal complications in this series demonstrated by clinical and Doppler examinations.
BACKGROUND: Proximal embolization of the splenic artery (PSAE) has recently been reported for traumatic splenic injury. The suggested mechanism of action entails a decrease in the splenic blood pressure without ischemia due to collateral blood supply. The main complications of selective embolization are continuous bleeding, splenic infarcts and splenic abscesses. The main complications of observation alone are continuous bleeding and formation of splenic pseudoaneurysms. Our aim was to assess the efficacy of PSAE in the cessation of bleeding without formation of pseudoaneurysms, and the outcome of the spleen after such intervention. METHODS: A prospective observational study of all patients undergoing PSAE for traumatic splenic injury in our institution over a 33-month period. Clinical and Doppler sonographic examinations were performed to assess cessation of bleeding, splenic blood flow, and formation of splenic pseudoaneurysms, infarcts or abscesses. RESULTS: During 33 months, 11 patients with blunt abdominal trauma and tomographic evidence of either high grade or actively bleeding splenic injuries were treated by PSAE. During follow-up, no patient underwent surgery or repeated embolization. Preserved blood flow was found on Doppler sonography in 82% of the patients and no pseudoaneurysms were demonstrated. A perisplenic collection was found in one patient and responded well to percutaneous drainage. CONCLUSIONS: Proximal embolization of the splenic artery for severe splenic injury is highly successful in cessation of bleeding while preserving splenic architecture. There were minimal complications in this series demonstrated by clinical and Doppler examinations.
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