scholarly journals Quantity of hemoperitoneum is associated with need for intervention in patients with stable blunt splenic injury

2020 ◽  
Vol 5 (1) ◽  
pp. e000406
Author(s):  
Kristin Salottolo ◽  
Robert M Madayag ◽  
Michael O'Brien ◽  
James Yon ◽  
Allen Tanner ◽  
...  
Keyword(s):  
Splenic Injury ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Artery Embolization ◽  
Level Of Evidence ◽  
Splenic Artery Embolization ◽  
Blunt Splenic Injury ◽  
Management Algorithm ◽  
Definitive Management ◽  
Successful Observation

BackgroundIn patients with hemodynamically stable blunt splenic injury (BSI), there is no consensus on whether quantity of hemoperitoneum (HP) is a predictor for intervention with splenic artery embolization (SAE) or failing nonoperative management (fNOM). We sought to analyze whether the quantity of HP was associated with need for intervention.MethodsThis retrospective cohort study included adult trauma patients with hemodynamically stable BSI admitted to six trauma centers between 2014 and 2016. Quantity of HP was defined as small (perisplenic blood or blood in Morrison’s pouch), moderate (blood in one or both pericolic gutters), or large (additional finding of free blood in the pelvis). Multivariate logistic regression was performed to identify predictors of intervention with SAE or fNOM versus successful observation.ResultsThere were 360 patients: hemoperitoneum was noted in 214 (59%) patients, of which the quantity was small in 92 (43%), moderate in 76 (35.5%), and large in 46 (21.5%). Definitive management was as follows: 272 (76%) were observed and 88 (24%) had intervention (83 SAE, 5 fNOM). The rate of intervention was univariately associated with quantity of HP, even after stratification by American Association for the Surgery of Trauma (AAST) grade. After adjustment, larger quantities of HP significantly increased odds of intervention (p=0.01). Compared with no HP, the odds of intervention were significantly increased for moderate HP (OR=3.51 (1.49 to 8.26)) and large HP (OR=2.89 (1.03 to 8.06)), with similar odds for small HP (OR=1.21 (0.46 to 2.76)). Other independent predictors of intervention were higher AAST grade, older age, and presence of splenic vascular injury.ConclusionGreater quantity of HP was associated with increased odds of intervention, with no difference in risk for moderate versus large HP. These findings suggest quantity of HP should be incorporated in the management algorithm of BSI as a consideration for angiography and/or embolization to maximize splenic preservation and reduce the risk of splenic rupture.Level of evidenceIII, retrospective epidemiological study.

scholarly journals Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes

2021 ◽  
Vol 38 (01) ◽  
pp. 105-112
Author(s):  
Majd Habash ◽  
Darrel Ceballos ◽  
Andrew J. Gunn
Keyword(s):  
Clinical Outcomes ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Operative Management ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
High Grade ◽  
Artery Embolization ◽  
Splenic Artery Embolization

AbstractThe spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.

scholarly journals Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

2011 ◽  
Vol 35 (1) ◽  
pp. 76-81 ◽  
Author(s):  
C. H. van der Vlies ◽  
J. Hoekstra ◽  
K. J. Ponsen ◽  
J. A. Reekers ◽  
O. M. van Delden ◽  
...  
Keyword(s):  
Success Rate ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Blunt Splenic Injury

scholarly journals Predictors of splenic artery embolization as an adjunct to non-operative management of stable blunt splenic injury: a multi-institutional study

2019 ◽  
Vol 4 (1) ◽  
pp. e000323 ◽  
Author(s):  
Kristin Salottolo ◽  
Matthew M Carrick ◽  
Robert M Madayag ◽  
James Yon ◽  
Allen Tanner ◽  
...  
Keyword(s):  
Splenic Artery ◽  
Splenic Injury ◽  
Motor Vehicle ◽  
Multivariate Logistic Regression Analysis ◽  
Operative Management ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Radiographic Findings ◽  
Blunt Splenic Injury ◽  
Non Operative Management

BackgroundWe sought to identify predictors of splenic artery embolization (SAE) over observation for hemodynamically stable patients with blunt splenic injury (BSI), by Organ Injury Scale (OIS) grade.MethodsThis was a multi-institutional retrospective study of all adults (≥18) with BSI who were initially managed non-operatively between 2014 and 2016. Multivariate logistic regression analysis was used to identify predictors of SAE by OIS grade. Covariates included radiographic characteristics (presence/quantity of hemoperitoneum, blush, vascular injury), demographics (age, sex, cause), Injury Severity Score, vital signs, and hemoglobin values. We also examined outcomes of death, length of stay (LOS), intensive care unit (ICU) admission, blood products, and failed non-operative management (NOM).ResultsAmong 422 patients with stable BSI, 93 (22%) had SAE and 329 (78%) were observed. The rate of SAE increased by grade (p<0.001). In grade I and II BSI, 7% had SAE; significant predictors of SAE were blush (OR: 5.9, p=0.02), moderate or large hemoperitoneum (OR: 3.0, p=0.01), and male sex (OR: 6.3, p=0.05). In grade III BSI, 26% had SAE; significant predictors included moderate or large hemoperitoneum (OR: 3.9, p=0.04), motor vehicle crash (OR: 6.1, p=0.005), and age (OR=1.4, 40% with each decade increase in age, p=0.02). The rate of SAE was 52% for grade IV and 85% for grade V BSI; there were no independent predictors of SAE in either grade. Clinical outcomes were comparable by NOM strategy and grade, except longer LOS with SAE in grades I–III (p<0.05) and longer ICU LOS with SAE in grades I–IV (p<0.05). Only 5 (1.2%) patients failed NOM (4 observation, 1 SAE).ConclusionThese results strongly support SAE consideration for patients with stable grade IV and V BSI even if there are no other high-risk clinical or radiographic findings. For grades I–III, the identified predictors may help refine consideration for SAE.Level of evidenceLevel III, retrospective epidemiological study.

Proximal Splenic Artery Embolization for Blunt Splenic Injury: Clinical, Immunologic, and Ultrasound-Doppler Follow-Up

2007 ◽  
Vol 62 (6) ◽  
pp. 1481-1486 ◽  
Author(s):  
Bertrand Bessoud ◽  
Michel A. Duchosal ◽  
Claire-Anne Siegrist ◽  
Susanna Schlegel ◽  
Francesco Doenz ◽  
...  
Keyword(s):  
Splenic Artery ◽  
Splenic Injury ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Blunt Splenic Injury ◽  
Ultrasound Doppler

scholarly journals Blunt Splenic Injury: Efficacy of Superselective Splenic Artery Embolization

2014 ◽  
Vol 3 (2) ◽  
pp. 37-48
Author(s):  
CP Chou ◽  
YH Kim ◽  
S Tresoldi ◽  
EI Tikh ◽  
S Baker ◽  
...  
Keyword(s):  
Splenic Artery ◽  
Splenic Injury ◽  
Pancreatic Injury ◽  
Organ Injury ◽  
Splenic Trauma ◽  
Artery Embolization ◽  
Safe Alternative ◽  
Splenic Artery Embolization ◽  
Blunt Splenic Injury ◽  
Catheter Technique

Objective: To evaluate the efficacy of superselective splenic artery embolization (SAE) using a coaxial catheter technique in patients with blunt splenic injury. Patient Selection and Methods: We retrospectively reviewed cases of 24 consecutive patients undergoing splenic angiography for blunt splenic injury at a Level 1 trauma center. After angiographic confirmation of splenic injury, superselective SAE was performed using gelfoam pledgets (n=15), with or without coils, and liquid embolic materials (n=9). All procedures were performed through a microcatheter advanced coaxially through a selective angiographic catheter. Severity of splenic injury was graded using CT imaging. The angiographic findings were retrospectively divided into four groups. Outcome measures included technical success, complications and recurrence of symptoms requiring additional intervention or surgery despite embolization. Results: All cases were technically successful, with immediate occlusion of targeted vessels after embolization. One patient underwent distal pancreatectomy- splenectomy 3 days after splenic embolization due to symptoms related to distal pancreatic injury, unrelated to the angiographic intervention. A second embolization was performed 1-3 days after initial embolization in 4 patients with clinical suspicion of re-bleeding. One of these four patients underwent splenectomy 3 days after the second embolization, during exploration for associated bowel and diaphragmatic injury. A second patient underwent splenectomy 1 day after a second embolization due to need for continued transfusions. The splenic salvage rate was not significantly related to CT grade of splenic injury (p=1.0) or angiographic classification (p=0.8). Conclusion: Superselective SAE can be performed as a safe alternative to splenectomy in patients with blunt splenic trauma, particularly when there is no additional major organ injury. DOI: http://dx.doi.org/10.3126/njr.v3i2.9606 Nepalese Journal of Radiology Vol.3(2)July-Dec, 2013: 37-48

Use of Splenic Artery Embolization as an Adjunct to Nonsurgical Management of Blunt Splenic Injury

2004 ◽  
Vol 56 (4) ◽  
pp. 768-773 ◽  
Author(s):  
Po Ping Liu ◽  
Wei Che Lee ◽  
Yu Fan Cheng ◽  
Pei Min Hsieh ◽  
Yu Min Hsieh ◽  
...  
Keyword(s):  
Splenic Artery ◽  
Splenic Injury ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Blunt Splenic Injury ◽  
Nonsurgical Management
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