We aimed to emphasize that minimally invasive approaches and multidisciplinary care can be utilized in the treatment of critically ill patients with accompanying. When embolization is planned, visualization of the pancreatic arteries and gastric. Embolization that occurred distal to the main splenic artery trunk was considered to be distal. Splenic artery embolization before laparoscopic splenectomy. Splenic embolization for portal hypertension full text view.
Proximal sae was defined as the embolization of the main trunk of the splenic artery in a proximal location. Splenic artery aneurysms saas are the third most common abdominal aneurysm preceded only by aortic and iliac artery aneurysms, and comprise the majority of visceral artery aneurysms. Splenic laceration with embolization radiology case. Completion arteriography was performed from the proximal main splenic artery to ensure cessation of flow and absence of additional injury.
Transcatheter arterial embolization of splenic artery aneurysms. Splenic embolization has been shown to increase the success rate of nonoperative management. 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. Selective splenic artery embolization for the treatment of. The success rate of splenic embolization ranges from 75% to 100%. Partial splenic artery embolization in cirrhotic patients. Our institutional clinical pathway calls for embo in the setting of ongoing splenic bleeding or contrast blush on computed tomography scan. Splenic trauma background the spleen is the solid organ most frequently injured in blunt abdominal trauma. Traditionally, splenectomy is considered the treatment of choice. Proximal splenic artery embolization, via deployment of coils or an amplatzer plug in the splenic artery immediately distal to the pancreatic and short gastric arteries, has been established as a safe and effective option in the nonsurgical management of sass 3942. Pnh is associated with abdominal vein thrombosis, which can cause splenomegaly and hypersplenism. Splenic embolization in hypersplenic thrombocytopenia. The spleen is the second most commonly injured organ in cases of abdominal trauma.
Now that nonoperative management is well accepted in haemodynamically stable patients, one has to mention that splenic artery embolization plays a major role in this clinical setting by allowing a higher number of patients to be integrated into the nonoperative management group. Portosplenic blood flow separation by occluding the splenic vein could avoid the complication of severe portal hypertension, but it would require repeated reintervention due to recurrence of symptoms. Interventional treatment strategies for patients with encephalopathy due to splenorenal shunt remain controversial. Preoperative splenic artery embolization was used in 26 of 54 patients 48% undergoing laparoscopic splenectomy. Partial splenic artery embolization in cirrhosis is a safe. All you need to know about splenic arterial embolisation. History of splenic embolization for ph tn 19731 first report of complete splenic embolization autologous clot used to embolize the spleen of a farmer with recurrent esophageal variceal bleeding subsequent cases major complications abscess, septic shock, splenic rupture 19792 suggested limited embolization splenic artery embolization. Review article clinical application of partial splenic. Farsad receives research from guerbet and terumo and honoraria from w. The main splenic artery is then catheterized and a splenic arteriogram performed. Transplantation replaces a cirrhotic liver with a normal liver and relieves the mechanical component of portal hypertension but does not immediately restore the systemic or splanchnic circulation to normal. Chung and reuter 2 embolized the splenic artery in dogs and found the spleen to be shrunken and fibrosed at 8 weeks. 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.
The major disadvantage of the splenic vein embolization previously reported by zamora et al. Has anyone any knowledge of what to expect after splenic. Nov 03, 2014 splenic embolization was first introduced in 1973, when autologous blood clot was used by maddison to produce splenic artery embolization for hypersplenism treatment. Splenic artery embolization diagnostic and interventional radiology. Partial splenic embolization platelet disorder support. This technique may also reduce the risk of surgery by. By hanno hoppe, md, ebir, fcirse, and sebastian kos, md, ebir, fcirse. Refractory ascites ra is a rare complication after adult orthotopic liver transplantation. In the past 3 decades, the treatment of traumatic splenic inju. A micro catheter was placed across the site of splenic artery rup ture, then splenic artery embolization was performed with multiple coils including 6 mm in diameter tornado. Pdf splenic liquefaction after splenic artery embolization. It branches from the celiac artery, and follows a course superior to the pancreas. Mar 27, 2014 splenectomy could alleviate thrombocytopenia and reduce portal pressure, but it can cause postoperative thromboses and opportunistic infections.
Two primary techniques of splenic artery embolization have been described. Two unusual but treatable causes of refractory ascites after liver transplantation, cardiovascular and interventional radiology, 2015, 38, 6. Review of proximal splenic artery embolization in blunt abdominal. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion. The site of splenic artery injury corresponded to the encased portion of the artery between the left ad renal mass and posterior wall of the stomach. Any information contained in this pdf file is automatically generated from digital. It is an especially useful for the treatment of variceal bleeding due to hepatic cirrhosis. Splenic artery embolization as an adjunctive procedure for portal. Stainless steel spring coils or detachable balloons placed in a main branch of the splenic artery would temporally reduce the portal vein pressure and prevent the esophageal varices bleeding, with basically the same effects of ligation of the splenic artery. Splenic artery embolization is a safe and effective alternative to surgical splenectomy, especially in patients who are poor surgical candidates due to associated comorbidities.
Wed like to understand how you use our websites in order to improve them. Background the spleen is the second most commonly injured organ in cases of abdominal trauma. In proximal embolization, the splenic artery is selectively catheterized. Embolization was performed injecting polyvinyl particles of approximately 500700 antibiotics were also. Sep, 2016 the spleen is the second most commonly injured organ in cases of abdominal trauma. 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. Splenic artery embolization for nonsurgical splenectomy.
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 contemporary management of splenic artery aneurysms. Seven years later, transcatheter partial splenic embolization pse was developed by spigos et al.
Preliminary selective splenic angiography, confirming splenic upper pole laceration with active bleedingpseudoaneurysm formation. We report a rare case of 27year old patient in 24th week of pregnancy with. Splenic artery embolization for massive splenomegaly. Splenic vein thrombosis is a relatively common finding in pancreatitis. The increased susceptibility of patients to infections after splenectomy has led to the use of splenic preservation procedures 4, 5. 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. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm group i, except the first two 1820. 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. Sep 05, 20 has anyone any knowledge of what to expect after splenic artery embolization. All you need to know about splenic arterial embolisation or. 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.
Boston scientific, natick, ma are placed as distally and near to the injured vessel as possible. The splenic artery or lienal artery is the blood vessel that supplies oxygenated blood to the spleen. Splenic artery embolization has been used as an adjunct to nonsurgical treatment of blunt splenic injuries. Splenic trauma can also be treated by embolization of the splenic artery. Splenic arteriogastric fistula resulting from adrenocortical. Further, embolization dramatically increases the success rate of patients in. Partial splenic embolization as a treatment for hypersplenis. Splenic artery embolization for the treatment of gastric. Splenic blunt trauma from diagnostic mdct to embolisation.
Splenic artery aneurysms saa is very rare and uncommon condition what makes it difficult in diagnosis and treatment. In another study, one episode of splenic infarction associated with sever pancreatitis was noted after embolization of a distal splenic artery aneurysm. Has anyone any knowledge of what to expect after splenic artery embolization. Maddison 3 reported a successful medical splenectomy in a patient who underwent selective splenic arterial embolization. Failure of nonoperative management caused by delayed splenic haemorrhage occurs in 2% to 20% of patients. 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. If a distal embolization procedure is to be performed, a microcatheter and wire combination e. 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. Incidental diagnosis is often presumptive based on circular calcified shadows seen in the left upper quadrant of an. The spleen is high ly vascular and is the most commonly injured visceral organ in blunt abdominal trauma 2. Only if haemodynamically stable no hollow viscus injury ct scan available to grade the solid organ injury icu or high dependency bed available for monitoring not more than 23units for transfusion in 24hrs.
This study assessed preoperative splenic artery embolization before laparoscopic splenectomy. The combination of thrombosis, splenomegaly, and thrombocytopenia tst is challenging because anticoagulants are indicated but thrombocytopenia may increase the bleeding risk. Splenic artery embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. Management of splenic injury depends on the clinical status of the patient and can include nonoperative management nom. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and. Here we report our experience on pse in eight hivhcvcoinfected patients unable to tolerate an interferonribavirin regimen because of thrombocytopenia secondary to hypersplenism table 1. A secondary aim is to evaluate the relative efficacy of two separate splenic artery embolization techniques, coiling versus particle embolization of the spleen. It was first described in 1981 by sclafani 3 and became more widely used in the late 1990s. Pneumococcal, haemophilus influenzae and quadrivalent meningococcal vaccines were administered, and, after written consent, a catheter was placed, via the femoral artery, in the splenic artery distal to the dorsal pancreatic branch. Single port surgery uses a special port that multiple instruments go through, unlike traditional laparoscopy where each port canfield only one instrument. Distal embolization of the lower pole segmental artery was performed with pushable coils arrow using a coaxial. Advantages of single port surgery are mostly cosmetic.
In this patient population, partial splenic embolization can decrease the incidence of variceal bleeding, and protection can persist for at least a year. Majercik, md, jeff jednacz, md, robert lambiase, md, and william g. 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. Therefore, we chose splenic vein embolization with the preservation of the splenorenal shunt and successfully treated it with a slight elevation 1. Splenic embolization for portal hypertension full text. The complications were caused by the partial splenic embolization procedure which had some leftover spleen that had to be fully removed. Splenic artery angioembolization embo has been promoted to increase the success rate of nonoperative management of splenic injuries. Splenic embolization procedure answers on healthtap. When embolization is planned, visualization of the pancreatic arteries is essential to reduce the risk of their unintended embolization. Splenic arterial interventions rsna publications online. In nonoperatively managed cases, sae is sometimes used to control.
Transcatheter arterial embolization of splenic artery. Splenic vein embolization using coil anchors and prophylactic. The main splenic artery upper pole branch was then superselected, followed by transcatheter embolization with a total of 6 x fibered platinum coils vortx, boston scientific ranging from 26 mm diameter to acceptable stasis. Gastric variceal bleeding is a lifethreatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Partial splenic embolization pse has proved to be a useful method to resolve thrombocytopenia caused by hypersplenism. A singlecenter experience taein yoon, taewon kwon, hyunwook kwon, youngjin han, and yongpil cho division of vascular surgery, department of surgery, asan medical center, university of ulsan college of medicine, seoul, korea. The surgeon planned for lacroscopic splenectomy, but there were some complications, so woke up with open splenectomy being done. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Splenic artery embolization for the treatment of refractory.
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