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

Abstract

The 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.

Keywords

interventional radiology - trauma - hemorrhage - embolization - spleen

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2021

• References

• 1 Powell M, Courcoulas A, Gardner M. et al. Management of blunt splenic trauma: significant differences between adults and children. Surgery 1997; 122 (04) 654-660
• 2 Mebius RE, Kraal G. Structure and function of the spleen. Nat Rev Immunol 2005; 5 (08) 606-616
• 3 Peitzman AB, Heil B, Rivera L. et al. Blunt splenic injury in adults: multi-institutional study of the Eastern Association for the Surgery of Trauma. J Trauma 2000; 49 (02) 177-187 , discussion 187–189
• 4 Stein DM, Scalea TM. Nonoperative management of spleen and liver injuries. J Intensive Care Med 2006; 21 (05) 296-304
• 5 Banerjee A, Duane TM, Wilson SP. et al. Trauma center variation in splenic artery embolization and spleen salvage: a multicenter analysis. J Trauma Acute Care Surg 2013; 75 (01) 69-74 , discussion 74–75
• 6 Haan JM, Bochicchio GV, Kramer N, Scalea TM. Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma 2005; 58 (03) 492-498
• 7 Requarth JA, D'Agostino Jr RB, Miller PR. Nonoperative management of adult blunt splenic injury with and without splenic artery embolotherapy: a meta-analysis. J Trauma 2011; 71 (04) 898-903 , discussion 903
• 8 Ahuja C, Farsad K, Chadha M. An overview of splenic embolization. AJR Am J Roentgenol 2015; 205 (04) 720-725
• 9 Bessoud B, Denys A, Calmes JM. et al. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization?. AJR Am J Roentgenol 2006; 186 (03) 779-785
• 10 Rajani RR, Claridge JA, Yowler CJ. et al. Improved outcome of adult blunt splenic injury: a cohort analysis. Surgery 2006; 140 (04) 625-631 , discussion 631–632
• 11 Arvieux C, Frandon J, Tidadini F. et al. Splenic arterial embolization to avoid splenectomy (SPLASH) study group - effect of prophylactic embolization on patient with blunt trauma at high risk of splenectomy: a randomized clinical trial. JAMA Surg 2020; 155 (12) 1102-1111
• 12 Schnüriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma 2011; 70 (01) 252-260
• 13 Bessoud B, Duchosal MA, Siegrist CA. et al. Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up. J Trauma 2007; 62 (06) 1481-1486
• 14 Killeen KL, Shanmuganathan K, Boyd-Kranis R, Scalea TM, Mirvis SE. CT findings after embolization for blunt splenic trauma. J Vasc Interv Radiol 2001; 12 (02) 209-214
• 15 Jabbour G, Al-Hassani A, El-Menyar A. et al. Clinical and radiological presentations and management of blunt splenic trauma: a single tertiary hospital experience. Med Sci Monit 2017; 23: 3383-3392
• 16 Khan SA, Muhammad I, Laabei F, Rothwell J. An unusual presentation of non pathological delayed splenic rupture: a case report. Cases J 2009; 2: 6450
• 17 Chadburn A. The spleen: anatomy and anatomical function. Semin Hematol 2000; 37 (01) (Suppl. 01) 13-21
• 18 Rostas JW, Lively TB, Brevard SB, Simmons JD, Frotan MA, Gonzalez RP. Rib fractures and their association with solid organ injury: higher rib fractures have greater significance for solid organ injury screening. Am J Surg 2017; 213 (04) 791-797
• 19 Makoba IG. Splenic injury following trauma: the role of ultrasonography. Afr Health Sci 2001; 1 (01) 23-25
• 20 Savatmongkorngul S, Wongwaisayawan S, Kaewlai R. Focused assessment with sonography for trauma: current perspectives. Open Access Emerg Med 2017; 9: 57-62
• 21 Doody O, Lyburn D, Geoghegan T, Govender P, Munk PL, Torreggiani WC. Blunt trauma to the spleen: ultrasonographic findings. Clin Radiol 2005; 60 (09) 968-976
• 22 Uyeda JW, LeBedis CA, Penn DR, Soto JA, Anderson SW. Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT. Radiology 2014; 270 (01) 99-106
• 23 Coccolini F, Montori G, Catena F. et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 2017; 12: 40
• 24 Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995; 38 (03) 323-324
• 25 Rowell SE, Biffl WL, Brasel K. et al. Western Trauma Association Critical Decisions in Trauma: management of adult blunt splenic trauma-2016 updates. J Trauma Acute Care Surg 2017; 82 (04) 787-793
• 26 Miller PR, Chang MC, Hoth JJ. et al. Prospective trial of angiography and embolization for all grade III to V blunt splenic injuries: nonoperative management success rate is significantly improved. J Am Coll Surg 2014; 218 (04) 644-648
• 27 White RD, Weir-McCall JR, Sullivan CM. et al. The celiac axis revisited: anatomic variants, pathologic features, and implications for modern endovascular management. Radiographics 2015; 35 (03) 879-898
• 28 Pandey SK, Bhattacharya S, Mishra RN, Shukla VK. Anatomical variations of the splenic artery and its clinical implications. Clin Anat 2004; 17 (06) 497-502
• 29 Bertelli E, Di Gregorio F, Mosca S, Bastianini A. The arterial blood supply of the pancreas: a review. V. The dorsal pancreatic artery. An anatomic review and a radiologic study. Surg Radiol Anat 1998; 20 (06) 445-452
• 30 Gregorczyk M, Dabkowska A, Tarka S, Ciszek B. The anatomy of the fundic branches of the stomach: preliminary results. Folia Morphol (Warsz) 2008; 67 (02) 120-125
• 31 Jean-Philippe Adam, Alexandre Jacquin, Christophe Laurent. et al. Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg 2013; 148 (03) 246-252
• 32 Imbrogno BF, Ray CE. Splenic artery embolization in blunt trauma. Semin Intervent Radiol 2012; 29 (02) 147-149
• 33 Bessoud B, Denys A. Main splenic artery embolization using coils in blunt splenic injuries: effects on the intrasplenic blood pressure. Eur Radiol 2004; 14 (09) 1718-1719
• 34 Rong JJ, Liu D, Liang M. et al. The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis. Mil Med Res 2017; 4: 17
• 35 Malhotra AK, Carter RF, Lebman DA. et al. Preservation of splenic immunocompetence after splenic artery angioembolization for blunt splenic injury. J Trauma 2010; 69 (05) 1126-1130 , discussion 1130–1131
• 36 Olthof DC, Lammers AJ, van Leeuwen EM, Hoekstra JB, ten Berge IJ, Goslings JC. Antibody response to a T-cell-independent antigen is preserved after splenic artery embolization for trauma. Clin Vaccine Immunol 2014; 21 (11) 1500-1504
• 37 Pirasteh A, Snyder LL, Lin R. et al. Temporal assessment of splenic function in patients who have undergone percutaneous image-guided splenic artery embolization in the setting of trauma. J Vasc Interv Radiol 2012; 23 (01) 80-82
• 38 Okabayashi T, Hanazaki K. Overwhelming postsplenectomy infection syndrome in adults - a clinically preventable disease. World J Gastroenterol 2008; 14 (02) 176-179
• 39 Tahir F, Ahmed J, Malik F. Post-splenectomy sepsis: a review of the literature. Cureus 2020; 12 (02) e6898
• 40 Olthof DC, van der Vlies CH, Goslings JC. Evidence-based management and controversies in blunt splenic trauma. Curr Trauma Rep 2017; 3 (01) 32-37
• 41 Ekeh AP, Khalaf S, Ilyas S, Kauffman S, Walusimbi M, McCarthy MC. Complications arising from splenic artery embolization: a review of an 11-year experience. Am J Surg 2013; 205 (03) 250-254 , discussion 254
• 42 Parihar ML, Kumar A, Gamanagatti S. et al. Role of splenic artery embolization in management of traumatic splenic injuries: a prospective study. Indian J Surg 2013; 75 (05) 361-367
• 43 Haan JM, Biffl W, Knudson MM. et al; Western Trauma Association Multi-Institutional Trials Committee. Splenic embolization revisited: a multicenter review. J Trauma 2004; 56 (03) 542-547
• 44 Peitzman AB, Harbrecht BG, Rivera L, Heil B. Eastern Association for the Surgery of Trauma Multiinstitutional Trials Workgroup. Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg 2005; 201 (02) 179-187
• 45 McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg 2005; 140 (06) 563-568 , discussion 568–569