Splenic Trauma: Technical Considerations and Management of Complications

Abstract

Splenic artery embolization has become an important tool in the management of splenic trauma. This review discusses the indications, anatomy, devices, techniques, and complications associated with splenic artery embolization.

Keywords

trauma - spleen - splenic artery embolization - proximal - distal - technique - complications

Publication History

Received: 31 March 2022

Accepted: 28 June 2022

Article published online:
28 September 2022

• References

• 1 Sclafani SJ. The role of angiographic hemostasis in salvage of the injured spleen. Radiology 1981; 141 (03) 645-650
• 2 Cullingford GL, Watkins DN, Watts AD, Mallon DF. Severe late postsplenectomy infection. Br J Surg 1991; 78 (06) 716-721
• 3 Schwartz PE, Sterioff S, Mucha P, Melton III LJ, Offord KP. Postsplenectomy sepsis and mortality in adults. JAMA 1982; 248 (18) 2279-2283
• 4 Kyaw MH, Holmes EM, Toolis F. et al. Evaluation of severe infection and survival after splenectomy. Am J Med 2006; 119 (03) 276.e1-276.e7
• 5 Gaarder C, Dormagen JB, Eken T. et al. Nonoperative management of splenic injuries: improved results with angioembolization. J Trauma 2006; 61 (01) 192-198
• 6 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
• 7 Sabe AA, Claridge JA, Rosenblum DI, Lie K, Malangoni MA. The effects of splenic artery embolization on nonoperative management of blunt splenic injury: a 16-year experience. J Trauma 2009; 67 (03) 565-572 , discussion 571–572
• 8 Stassen NA, Bhullar I, Cheng JD. et al; Eastern Association for the Surgery of Trauma. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73 (05, Suppl 04) S294-S300
• 9 Zarzaur BL, Dunn JA, Leininger B. et al. Natural history of splenic vascular abnormalities after blunt injury: a Western Trauma Association multicenter trial. J Trauma Acute Care Surg 2017; 83 (06) 999-1005
• 10 Girard E, Abba J, Cristiano N. et al. Management of splenic and pancreatic trauma. J Visc Surg 2016; 153 (4, Suppl): 45-60
• 11 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
• 12 Kozar RA, Crandall M, Shanmuganathan K. et al; AAST Patient Assessment Committee. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg 2018; 85 (06) 1119-1122
• 13 Ahuja C, Farsad K, Chadha M. An overview of splenic embolization. AJR Am J Roentgenol 2015; 205 (04) 720-725
• 14 Becker CD, Mentha G, Terrier F. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1: liver and spleen. Eur Radiol 1998; 8 (04) 553-562
• 15 Imbrogno BF, Ray CE. Splenic artery embolization in blunt trauma. Semin Intervent Radiol 2012; 29 (02) 147-149
• 16 Rong J-J, 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
• 17 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
• 18 Quencer KB, Smith TA. Review of proximal splenic artery embolization in blunt abdominal trauma. CVIR Endovasc 2019; 2 (01) 11
• 19 Requarth JA. Distal splenic artery hemodynamic changes during transient proximal splenic artery occlusion in blunt splenic injury patients: a mechanism of delayed splenic hemorrhage. J Trauma 2010; 69 (06) 1423-1426
• 20 Madoff DC, Denys A, Wallace MJ. et al. Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics 2005; 25 (Suppl. 01) S191-S211
• 21 Hamers RL, Van Den Berg FG, Groeneveld AB. Acute necrotizing pancreatitis following inadvertent extensive splenic artery embolisation for trauma. Br J Radiol 2009; 82 (973) e11-e14
• 22 Paul DB, Opalek JM. Proximal splenic arterial embolization may also result in pancreatic necrosis. J Trauma 2011; 71 (01) 268-269
• 23 Kadir S. Atlas of Normal and Variant Angiographic Anatomy. W.B. Saunders Company; 1991
• 24 Dasgupta N, Matsumoto AH, Arslan B, Turba UC, Sabri S, Angle JF. Embolization therapy for traumatic splenic lacerations. Cardiovasc Intervent Radiol 2012; 35 (04) 795-806
• 25 Wei B, Hemmila MR, Arbabi S, Taheri PA, Wahl WL. Angioembolization reduces operative intervention for blunt splenic injury. J Trauma 2008; 64 (06) 1472-1477
• 26 Loffroy R, Guiu B, Cercueil JP. et al. Transcatheter arterial embolization of splenic artery aneurysms and pseudoaneurysms: short- and long-term results. Ann Vasc Surg 2008; 22 (05) 618-626
• 27 Ruhnke H, Kröncke TJ. Visceral artery aneurysms and pseudoaneurysms: retrospective analysis of interventional endovascular therapy of 43 aneurysms. Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr 2017; 189 (07) 632-639
• 28 Wong YC, Wu CH, Wang LJ. et al. Distal embolization versus combined embolization techniques for blunt splenic injuries: comparison of the efficacy and complications. Oncotarget 2017; 8 (56) 95596-95605
• 29 Haan J, Scott J, Boyd-Kranis RL, Ho S, Kramer M, Scalea TM. Admission angiography for blunt splenic injury: advantages and pitfalls. J Trauma 2001; 51 (06) 1161-1165
• 30 Koconis KG, Singh H, Soares G. Partial splenic embolization in the treatment of patients with portal hypertension: a review of the English language literature. J Vasc Interv Radiol 2007; 18 (04) 463-481
• 31 “Amplatzer Vascular Plug II.” Abbott Cardiovascular.. Accessed July 25, 2022 at: https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/amplatzer-family/avp-ii.html
• 32 Freeman C, Moran V, Fang A, Isreal H, Ma S, Vyas K. Nonoperative management of blunt splenic trauma: outcomes of Gelfoam embolization of the splenic artery. J Emerg Trauma Shock 2018; 11 (04) 293-297
• 33 Wu SC, Chen RJ, Yang AD, Tung CC, Lee KH. Complications associated with embolization in the treatment of blunt splenic injury. World J Surg 2008; 32 (03) 476-482
• 34 Wang W, Tam MD, Spain J, Quintini C. Gelfoam-assisted Amplatzer vascular plug technique for rapid occlusion in proximal splenic artery embolization. AJR Am J Roentgenol 2013; 200 (03) 677-681
• 35 Lopera JE. Embolization in trauma: principles and techniques. Semin Intervent Radiol 2010; 27 (01) 14-28
• 36 Park SI, Lee SJ, Lee M. et al. Prospective randomized trial comparing pushable coil and detachable coil during percutaneous implantation of port-catheter system for hepatic artery infusion chemotherapy. Abdom Imaging 2015; 40 (03) 595-600
• 37 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
• 38 Ng EH, Comin J, David E, Pugash R, Annamalai G. Amplatzer Vascular Plug 4 for proximal splenic artery embolization in blunt trauma. J Vasc Interv Radiol 2012; 23 (07) 976-979
• 39 Wang W, Li H, Tam MD, Zhou D, Wang DX, Spain J. The Amplatzer vascular plug: a review of the device and its clinical applications. Cardiovasc Intervent Radiol 2012; 35 (04) 725-740
• 40 Widlus DM, Moeslein FM, Richard III HM. Evaluation of the Amplatzer vascular plug for proximal splenic artery embolization. J Vasc Interv Radiol 2008; 19 (05) 652-656
• 41 “Amplatzer Vascular Plug 4.” Abbott Cardiovascular.. Accessed July 25, 2022 at: https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/amplatzer-family-vascular-plugs/avp-4/avp-4-sizing-specs.html
• 42 Malhotra A, Siskin G. The MVP™ microvascular plug. A valuable addition to the armamentarium for peripheral embolization. Endovascular Today 2016; 15: 75-78
• 43 “MVP Micro Vascular Plug System for Peripheral Embolization.” Medtronic. . Accessed July 25, 2022 at: https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/peripheral-embolization/mvp.html
• 44 IMPEDE® Embolization Plug. . Lawrence Livermore National Laboratory, 2019. Accessed July 25, 2022 at: https://ipo.llnl.gov/content/assets/docs/award-archive/impede.pdf
• 45 Caterpillar and Caterpillar Micro Arterial Embolization Devices. Becton, Dickinson and Company.. Accessed July 25, 2022 at: https://www.bd.com/en-us/offerings/capabilities/vascular-surgery/vascular-occlusion/caterpillar-and-caterpillar-micro-arterial-embolization-devices
• 46 Adnan SM, Romagnoli AN, Martinson JR. et al. A comparison of transradial and transfemoral access for splenic angio-embolisation in trauma: a single centre experience. Eur J Vasc Endovasc Surg 2020; 59 (03) 472-479
• 47 Pillai AK, Bashir M, Ferral H, Paruchuri S, Domkan A. Median nerve injury as a result of medial brachial fascial compartment syndrome. J Vasc Interv Radiol 2007; 18 (11) 1434-1435
• 48 Frandon J, Rodière M, Arvieux C. et al. Blunt splenic injury: outcomes of proximal versus distal and combined splenic artery embolization. Diagn Interv Imaging 2014; 95 (09) 825-831
• 49 Frandon J, Rodiere M, Arvieux C. et al. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?. Diagn Interv Radiol 2015; 21 (04) 327-333
• 50 Scarborough JE, Ingraham AM, Liepert AE, Jung HS, O'Rourke AP, Agarwal SK. Nonoperative management is as effective as immediate splenectomy for adult patients with high-grade blunt splenic injury. J Am Coll Surg 2016; 223 (02) 249-258
• 51 Zarzaur BL, Kozar R, Myers JG. et al. The splenic injury outcomes trial: an American Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg 2015; 79 (03) 335-342
• 52 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
• 53 Corn S, Reyes J, Helmer SD, Haan JM. Outcomes following blunt traumatic splenic injury treated with conservative or operative management. Kans J Med 2019; 12 (03) 83-88
• 54 Cioci AC, Parreco JP, Lindenmaier LB. et al. Readmission for infection after blunt splenic injury: a national comparison of management techniques. J Trauma Acute Care Surg 2020; 88 (03) 390-395
• 55 Demetriades D, Scalea TM, Degiannis E. et al. Blunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study. J Trauma Acute Care Surg 2012; 72 (01) 229-234
• 56 Haan J, Bochicchio G, Kramer M, Scalea T. Air following splenic embolization: infection or incidental finding?. Am Surg 2003; 69 (12) 1036-1039 , discussion 1039–1040
• 57 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
• 58 Schimmer JA, van der Steeg AF, Zuidema WP. Splenic function after angioembolization for splenic trauma in children and adults: a systematic review. Injury 2016; 47 (03) 525-530
• 59 Skattum J, Loekke RJ, Titze TL. et al. Preserved function after angioembolisation of splenic injury in children and adolescents: a case control study. Injury 2014; 45 (01) 156-159
• 60 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