Ces radiol. 2018, 72(2):106-112 | DOI: 10.55095/CesRadiol2018/018

Role of embolisation in bleeding from lacerated spleenOriginal article

Antonín Krajina1, Tomáš Dědek2, Jaromír Kočí2, Jan Raupach1, Vendelín Chovanec1, Miroslav Lojík1, Ondřej Renc1, Radek Štichhauer3, Jaroslav Koudelka3, Eva Kočová1, Pavel Rejtar1, Zdeněk Turek4, Lucie Nepovímová5, Petr Dvořák1, Pavel Ryška1
1 Radiologická klinika LF a FN, Hradec Králové
2 Chirugická klinika LF a FN, Hradec Králové
3 Oddělení dětské chirurgie a traumatologie LF a FN, Hradec Králové
4 Klinika anestezie a resuscitace LF a FN, Hradec Králové
5 Oddělení infekce, Nemocnice Pardubice

Purpose: Embolisation of the splenic artery has become routine part of conservative therapy of patients with injury of the spleen and spontaneous splenic rupture. The goal of our study was assessment of our series of patients.

Methods: Our study is a retrospecitve analysis of results of embolisation therapy in patients with injured spleen who were not primarily indicated for surgical therapy in 2016 and 2017.

Results: There were 10 patients included in the study. Three of them had polytrauma, six had isolated laceration of the spleen due to blunt abdominal trauma, and one woman suffered from spontaneous rupture of the spleen having underlying myeloproliferative syndrome. All patients had contrast enhanced CT scan of the abdominal cavity and angiography. Embolisation was performed in eight patiens. There was no recurrent bleeding in all embolised patiens, and in 7 of them the spleen was preserved. One patient underwent splenectomy for high risk of subphrenic abscess development in immunocompromised setting the other day. On contrary one nonembolised patient had delayed rupture of the spleen which neccessitated splenectomy. All ten patients fully recovered in follow up of 3-24 months.

Conclusions: Embolisation in nonoperative management of splenic hemorrhage saved spleen in 7 out of 8 (87.5%) embolised patients. Embolisation of the splenic artery is a significant part of protocol of conservative therapy of patients with injury of the spleen.

Keywords: spleen, embolisation, nonoperative management, blunt trauma

Accepted: April 4, 2018; Published: June 1, 2018  Show citation

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Krajina A, Dědek T, Kočí J, Raupach J, Chovanec V, Lojík M, et al.. Role of embolisation in bleeding from lacerated spleen. Ces radiol. 2018;72(2):106-112. doi: 10.55095/CesRadiol2018/018.
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    References

    1. Chang R, Fox EE, Greene TJ, et al. Multicenter retrospective study of noncompressible torso hemorrhage: anatomic locations of bleeding and comparison of endovascular versus open approach. J Trauma Acute Care Surg 2017; 83(1): 11-18. Go to original source... Go to PubMed...
    2. Vajdík J. Spontánní ruptura slezinných cév v graviditě. Čs Gynekol 1984; 49: 770-784.
    3. Chvojka J. Arteriografická diagnostika poranění sleziny. Čs Radiol 1976; 30: 4.
    4. Srp A, Bruna L, Halman J, Vyhnánek F. Vyšetření sleziny výpočetní tomografií Čs Radiol 1989; 43(4): 230-236.
    5. Kovařík J, KÖcher M, Čižmář I, Palčák J. Zhodnocení výsledků embolizace sleziny u pacientů s polytraumatem - 4leté zkušenosti. Úraz chir 2013; 21(1): 17-23.
    6. Sclafani SJA. The role of angiographic hemostasis in salvage of injured spleen. Radiology 1981; 141: 645-650. Go to original source... Go to PubMed...
    7. Okabayashi T, Hanazaki K. Overwhelming postsplenectomy infection syndrome in adults - a clinically preventable disease. World J Gastroenterol 2008; 14(2): 176-179. Go to original source... Go to PubMed...
    8. Demetriades D, Scalea TM, Degiannis E, et al. Blunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study. J Trauma 2012; 7: 229-234. Go to original source... Go to PubMed...
    9. Vobořil Z. On the question of segmentation of the human spleen. Fol Morphol 1982; 30: 295-314.
    10. Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ Injury scaling: spleen and liver (1994 revision). J Trauma 1995; 38: 323-324. Go to original source... Go to PubMed...
    11. Notrica DM, Eubanks J, Tuggler DW, et al. Nonoperative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg 2015; 79: 683-693. Go to original source... Go to PubMed...
    12. Schnüriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan L, Demetriades D. Outcomes of proximal versus distal slenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma 2011; 70: 252-260. Go to original source... Go to PubMed...
    13. Frandon J, Rodiére M, Arvieux C, et al. Blunt splenic injury: outcomes of proximal versus distal and combined splenic artery embolization. Diagn Intervent Imaging 2014; 95: 825-831. Go to original source... Go to PubMed...
    14. Ahuja Ch, Farsad K, Chadha M. An overview of splenic embolization. AJR 2015; 205: 720-725. Go to original source... Go to PubMed...
    15. 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. Military Medical Research 2017; 4: 17. Go to original source... Go to PubMed...
    16. Wahl WL, Ahrns KS, Chen S, Hemilla MR, Rowe SA, Arbabi S. Blunt splenic injury: operation versus angiographic embolization. Surgery 2004; 136(4): 891-899. Go to original source... Go to PubMed...
    17. Zarzaur BI, 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: 335-342. Go to original source... Go to PubMed...
    18. Widlus DM, Moeslein FM, Richard III HM. Evaluation of the Amplatzer vascular plug for proximal splenic artery embolization. J Vasc Interv Radiol 2008; 19: 652-656. Go to original source... Go to PubMed...
    19. Petitpierre F, Lasserre AS, Tricaud E, et al. Proximal embolization of the splenic artery with a Penumbra occlusion device (POD): a novel occlusion technique for blunt splenic injuries. Cardiovasc Intervent Radiol 2016; 39: 309-312. Go to original source... Go to PubMed...
    20. Cullingford GL, Watkins DN, Watts AD, Mallon DF. Severe late postsplenectomy infection. Br J Surg 1991; 78: 716-721. Go to original source... Go to PubMed...
    21. Polák P, Kosina P, Blechová Z, et al. Doporučený postup péče o pacienty s porušenou či zaniklou funkcí sleziny (hyposplenismem/asplenií). www.Infekce.cz/DopOPSI13.htm
    22. Polák P, Freibergová M, Husa P, et al. Upozornění na nebezpečí invazivních infekcí u splenektomovaných pacientů. Zkušenosti z FN Brno. Vnitř. Lék. 2012; 58(9): 665-668.
    23. Foley PT, Kavnoudias H, Cameron PU, et al. Proximal versus distal splenic artery embolisation for blunt splenic trauma: what is the impact on splenic immune function? Cardiovasc Intervent Radiol 2015; 38: 1143-1151. Go to original source... Go to PubMed...
    24. Crichton JCHI, Naidoo K, Yet B, Brundage SI, Perkins Z. The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries: a systematic review and meta-analysis. J Traumat Acute Care Surg 2017; 83: 934-943. Go to original source... Go to PubMed...
    25. Bhullar IS, Tepas JJ, Siragusa D, Loper T, Kerwin A, Frykberg ER. To nearly come full circle: nonoperative management of high-grade IV-V blunt splenic trauma is safe using a protocol with routine angioembolization. J Trauma Acute Care Surg 2017; 82: 657-664. Go to original source... Go to PubMed...
    26. Schurr MJ, Fabian TC, Gavant M, et al. Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma Injury Infections Critical Care 1995; 39(3): 507-513. Go to original source... Go to PubMed...
    27. 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: 99-106. Go to original source... Go to PubMed...
    28. Stassen NA, Bhullar I, Cheng JD, et al. 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(5): S294-S300. Go to original source... Go to PubMed...
    29. Tominaga GT, Simon FJ, Dandan IS, et al. Immunologic function after splenic embolization, is there a difference? J Trauma 2009; 67(2): 289-295. Go to original source... Go to PubMed...
    30. Freitas G, Olufajo OA, Hammoouda K, et al. Postdischarge complications following nonoperative management of blunt splenic injury. Amer J Surg 2016; 211: 744-749. Go to original source... Go to PubMed...
    31. Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet 2011; 378(9785): 88-97. Go to original source... Go to PubMed...
    32. Rowell SE, Biffl WI, Brasel K, et al. Western Trauma Asscociation critical decisions in trauma: management of adult blunt splenic trauma - 2016 updates. J Trauma Acute Care Surg 2016; 82(4): 787-793. Go to original source... Go to PubMed...
    33. Hájková H, Havránek P, Buncová M. Neoperativní léčení traumatem poškozené sleziny u dětí. Rozhl Chir 1983; 62: 758-766.
    34. Skattum J, Jeanette R, Loekke V, et al. Preserved function after angioembolisation of splenic injury in children and adolescents: A case control study. Injury Int J Care Injured 2014; 45: 156-159. Go to original source... Go to PubMed...

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