scholarly journals Splenic artery embolisation in the non-operative management of blunt splenic trauma in adults

2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Richard J. Cormack ◽  
Mollie C.M. Ferris ◽  
Jason K. Wong ◽  
Stefan Przybojewski
Keyword(s):  
Blunt Trauma ◽  
Vascular Injury ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Operative Management ◽  
Trauma Centre ◽  
Splenic Trauma ◽  
Non Operative Management ◽  
Splenic Salvage ◽  
Salvage Rate

Background: The purpose of this study was to evaluate the splenic salvage rate with angioembolisation in the non-operative management (NOM) of blunt splenic injury.Methods: We conducted a retrospective analysis of patients presenting to our Level I trauma centre with computed tomography (CT)-confirmed splenic injury following blunt trauma and in whom angioembolisation was utilised in the algorithm of NOM. Data review included CT and angiography findings, embolisation technique and patient outcomes.Results: Between January 2005 and April 2010, 60 patients with splenic injury following blunt trauma underwent NOM, which included splenic artery embolisation (SAE). All patients included in the study required a preadmission. CT scan was used to document the American Association for the Surgery of Trauma (AAST) grade of splenic injury. The average injury grade was 3.0. The non-operative splenic salvage rate following SAE was 96.7% with statistically similar salvage rates achieved for grades II to IV injuries. The quantity of haemoperitoneum and the presence of a splenic vascular injury did not significantly affect the splenic salvage rate. The overall complication rate was 27%, of which 15% were minor and 13% were major.Conclusion: SAE is a safe and effective treatment strategy in the NOM of blunt splenic injury. The quantity of haemoperitoneum, the presence of vascular injury and embolisation technique did not significantly affect the splenic salvage rate.

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 Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives

Surgery Today ◽  
2020 ◽  
Author(s):  
Luigi Romeo ◽  
Francesco Bagolini ◽  
Silvia Ferro ◽  
Matteo Chiozza ◽  
Serafino Marino ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Current Knowledge ◽  
Operative Management ◽  
Current Status ◽  
Splenic Trauma ◽  
Future Perspectives ◽  
Encapsulated Bacteria ◽  
Non Operative Management

AbstractThe spleen is one of the organs most commonly injured by blunt abdominal trauma. It plays an important role in immune response to infections, especially those sustained by encapsulated bacteria. Nonoperative management (NOM), comprising clinical and radiological observation with or without angioembolization, is the treatment of choice for traumatic splenic injury in patients who are hemodynamically stable. However, this strategy carries a risk of failure, especially for high-grade injuries. No clear predictors of failure have been identified, but minimally invasive surgery for splenic injury is gaining popularity. Laparoscopic surgery has been proposed as an alternative to open surgery for hemodynamically stable patients who require surgery, such as after failed NOM. We reviewed research articles on laparoscopic surgery for hemodynamically stable patients with splenic trauma to explore the current knowledge about this topic. After presenting an overview of the treatments for splenic trauma and the immunological function of the spleen, we try to identify the future indications for laparoscopic surgery in the era of NOM.

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.

scholarly journals Recent Changes in the Management of Blunt Splenic Injury: Effect on Splenic Trauma Patients and Hospital Implications

2008 ◽  
Vol 90 (2) ◽  
pp. 109-112 ◽  
Author(s):  
S Sinha ◽  
SVV Raja ◽  
MH Lewis
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Splenic Injury ◽  
Transfusion Requirement ◽  
Operative Management ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Blunt Splenic Injury ◽  
Non Operative Management

INTRODUCTION Management of blunt splenic injury has been controversial with an increasing trend towards splenic conservation. A retrospective study was performed to identify the effect of this changed policy on splenic trauma patients and its implications. PATIENTS AND METHODS Data regarding patient demography, mode of splenic injury, CT grading, blood transfusion requirement, operative findings hospital stay and follow-up were collected. Statistical analysis of the data was performed using non-parametric Mann–Whitney tests RESULTS Over an 8-year period, only 21 patients were admitted with blunt splenic injury. Ten patients were managed operatively and 11 non-operatively. Non-operative management failed in one patient due to continued bleeding. Using Buntain's CT grading, the majority of grades I and II splenic injuries were managed non-operatively and grades III and IV were managed operatively (P = 0.008). Blood transfusion requirement was significantly higher among the operative group (P = 0.004) but the non-operative group had a significantly longer hospital stay (P = 0.029). Among those managed non-operatively (median age, 24.5 years), a number of patients were followed up with CT scans with significant radiation exposure and unknown long-term consequences. CONCLUSIONS Non-operative management of blunt splenic trauma in adults can be performed with an acceptable outcome. Although CT is classed as the ‘gold standard’, initial imaging for detection and evaluation of blunt splenic injury, ultrasound can play a major role in follow-up imaging and potentially avoids major radiation exposure.

scholarly journals Comparison of outcomes before and after establishing a regional trauma center and following a protocol to treat blunt splenic injury in South Korea: A retrospective study

2018 ◽  
Vol 25 (6) ◽  
pp. 343-349
Author(s):  
Min A Lee ◽  
Byungchul Yu ◽  
Jungnam Lee ◽  
Kang Kook Choi ◽  
Jae Jeong Park ◽  
...  
Keyword(s):  
South Korea ◽  
Trauma Center ◽  
Splenic Injury ◽  
Emergency Operation ◽  
Operative Management ◽  
Blunt Splenic Injury ◽  
Management Protocol ◽  
Before And After ◽  
Non Operative Management ◽  
Splenic Salvage

Background: Nonoperative management for hemodynamically stable splenic injury has been accepted as appropriate treatment. Objectives: This study aimed to investigate the changes in management and clinical outcomes of splenic injury by introducing a protocol for splenic injury at a newly established regional trauma center. Methods: From January 2005 to December 2016, we reviewed the outcomes of all 257 patients who sustained blunt trauma to the spleen at the first regional trauma center in South Korea. This 11-year period was divided into two intervals, before 1 January 2014 (period I, n = 189 patients) and after 1 January 2014 (period II, n = 68 patients), when the trauma center was established and a formal management protocol was followed for patients with blunt traumatic splenic injuries. Results: The proportion of emergency operations performed for patients with more serious (grades 3–5) splenic injuries was lower in period II than in period I (29% vs 22%, respectively, p < 0.001) whereas the rate of angioembolization was higher (89% vs 39.0%, respectively, p < 0.001). The time to intervention, irrespective of whether emergency operation or angioembolization was performed, was shorter in period II than in period I (312.8 min vs 129 min, respectively, p = 0.001). A greater proportion of patients was managed non-operatively in period II (78% vs 71%), and the non-operative management success rate was higher in period II than it was in period I (100% vs 83%; p = 0.014). Similarly, the splenic salvage rate was higher in period II (78% vs 59%, p = 0.03). Conclusion: After establishing a regional trauma center and introducing a protocol for the management of blunt splenic injuries, the rates of non-operative management and splenic salvage improved significantly. The reasons for this may be multifactorial, being related to the early involvement of a trauma surgeon, expansion of angiographic facilities and resources, and the introduction and application of a protocol for managing blunt splenic injury.

Splenic artery embolization with N-butyl cyanoacrylate in patients with blunt abdominal trauma

Trauma ◽  
2021 ◽  
pp. 146040862110009
Author(s):  
Sreeja Sanampudi ◽  
Driss Raissi
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Medical Center ◽  
Operative Management ◽  
Splenic Trauma ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Technical Success Rate

Introduction Splenic artery embolization (SAE) has been shown to be safe and effective for non-operative management of patients with splenic trauma while preserving splenic function. A variety of coils, plugs, particles and liquid embolics have all been used. NBCA (n-butyl cyanoacrylate) is used less frequently than other modalities but is effective. Methods A retrospective review of all patients who underwent SAE with NBCA for blunt abdominal trauma at a single tertiary medical center over a six-year period. Results Out of 123 SAE patients, 7 utilized NBCA; 6 patients had intraparenchymal splenic artery pseudoaneurysms, 2 had intraparenchymal arteriovenous fistulas, and 5 had active extravasation from the spleen on CT imaging. There was 100% technical success rate. There were no acute post-op complications or complications at 30-day and 90-day follow up. One patient died 2 days following SAE secondary to worsening subdural hematoma unrelated to SAE. Conclusions NBCA is safe and effective in treating patients with splenic injury particularly in patients with high grade splenic injury demonstrating extensive intraparenchymal vascular injury and/or intraprocedural extravasation in distal locations.

scholarly journals Non operative management of isolated traumatic splenic injury

2021 ◽  
Vol 8 (4) ◽  
pp. 1101
Author(s):  
Shiwani Thakur ◽  
Naseer Ahmed Awan ◽  
Umer Mushtaq ◽  
Shaukat Jeelani ◽  
M. R. Attri ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Splenic Injury ◽  
Statistical Significance ◽  
Operative Management ◽  
Successful Outcome ◽  
Blunt Injury ◽  
P Value ◽  
Splenic Trauma ◽  
High Dependency ◽  
Non Operative Management

Background: Road traffic accidents, sports injuries, assaults, and falls from height, are among most common causes of blunt splenic trauma. In 1970s, postsplenectomy complications were published by some authors, revealing the high mortality and morbidity related to overwhelming postsplenectomy infection (OPSI). Therefore, conservative management for splenic trauma was accepted as treatment of choice in all the patients to decrease mortality due to OPSI. Therefore, NOM of traumatic splenic injury has now been accepted as standard treatment of choice for all AAST grade I, II and III, whereas this was not found safe in higher grades of splenic trauma.  Methods: This is a hospital based prospective observational study, done on 45 hemodynamically stable patients of splenic trauma. Results: Out of all studied parameters grade of injury, contrast blush on CT scan, grade of hemoperitoneum showed statistical significance with p value<0.001, however gender, age, mode of injury, showed no statistical significance. In our study, out of 45 patients, 38 (84.44%) patients had successful NOM of splenic trauma.  Conclusions: Non-operative management (NOM) of blunt injury to the spleen in adults has become the standard of care in hemodynamically stable patients. This modality of treatment in paediatric patients is also highly successful and is standard treatment of choice in both adults and children. Success of NOM of isolated splenic injury depends on multiple factors such as availability of ICUs, high dependency units for strict monitoring, blood banks and availability of multidisciplinary team efforts encompassing anesthetics, trauma surgeons, radiologists, for successful outcome. 

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