We perceived a higher rate of failure than that reported in . Splenic artery embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. Splenic (artery) embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. embolization of splenic artery aneurysms and false aneurysms with special consideration given to postoperative complications in 15 patients (11 women; mean age of 56 years; range of 39 to 80 years) with splenic artery aneurysm (n = 13) or false aneurysm (n = 2) treated with coil embolization. Splenic artery embolization (SAE), as a novel treatment for hypersplenism, has been increasingly used in clinical practice over past decades. 7, 8 What is often under-appreciated is the impact of mechanism on mortality rates. To further understand the roles of different embolization locations and embolic materials in SAE, we conducted this system review and meta-analyses. There are several important technical considerations. The substances that are injected during this procedure include polyvinyl alcohol foam . Complete stasis was seen within the main splenic artery. The main splenic artery embolization was performed on the line segment (about 2mm) Fig. PSE is considered effective to control gastric variceal bleeding in patients with bleeding due . A recent meta-analysis evaluating the outcomes of proximal versus distal splenic artery embolization demonstrated increased complications, such as splenic infarction, after distal embolization. BackgroundSpontaneous splenic rupture (SSR) is a rare, often life-threatening, acute abdominal injury that requires immediate diagnosis and early treatment. Partial splenic artery embolization (PSE) has been used for a wide range of indications, including the control of bleeding in blunt splenic injuries, portal hypertension complications, and hypersplenism due to various etiologies. Splenic preservation can be accomplished via three routes: 1-bedrest and close monitoring alone (typically for grade I or II); 2- endovascular splenic artery embolization combined with bedrest and close monitoring (AAST grade III-V splenic injuries or with CT scans demonstrating pseudoaneurysms, traumatic arteriovenous fistula or extravasation); 3-surgical repair (known as splenorrhaphy). 2 CASE 1. , which has been proved as a safe and effective method of vascular occlusion. The surgery was performed uneventfully. You have received immunizations listed at the end of this document. Note . Ohmoto et al compared bleeding rates in 52 patients, half of whom were treated with splenic embolization in addition to variceal ligation. I72.2 Aneurysm of renal artery I72.3 Aneurysm of iliac artery I72.8 Aneurysm of other specified arteries (e.g., SMA, splenic, celiac, hepatic) Note: These diagnosis codes do not include those associated with traumatic injury. 6,7 The application of covered stent grafts allows for SAA exclusion while maintaining the blood flow in the splenic artery and is considered an ideal treatment. The increased susceptibility of patients to infections after splenectomy has led to the use of splenic preservation procedures [4, 5]. CONCLUSION. Methods Clinical studies related . Splenic injury to be treated by non-operative management as decided by attending trauma surgeon and interventional . SAE has been reported to be indicated for a number of conditions, including hypersplenism secondary to cirrhosis, portal hypertension, . Keywords: PNH, Thrombosis, Selective Splenic Artery embolization, Hypersplenism Background PNH is characterized by the triad of hemolytic anemia, cy-topenias and a high risk of venous thrombosis. A predominance of penetrating trauma is usually found in single-centre South African studies, with rates of over 90 per cent and an increased need for surgical intervention compared to only 19 per cent overall in a UK series and 22 per cent in a contemporary North American series. Recently, splenic artery embolization (SAE) has been described as an effective procedure for reducing portal hyperperfusion in patients undergoing partial or whole liver transplantation. Laparoscopically assisted splenectomy following preoperative splenic artery embolization using contour emboli for myelofibrosis with massive splenomegaly. Zhu, X., Tam, M. D. B. S., Pierce, G., McLennan, G., Sands, M. J., Lieber, M. S., & Wang, W. (2010). SSR is mainly treated surgically or conservatively. Splenic abscess is a rare and potentially life - threatening disease 6. Splenic artery embolization, which can preserve a portion of the spleen, is an alternative, if a patient has any contraindication for splenectomy . Citation, DOI & article data. 1 The higher incidence of complications, including septic shock, abscess formation, and postembolization syndrome, made PSE less popular compared to transjugular . scan confirmed the presence of a large (4.3 3.7-cm) splenic Transarterial embolization of visceral aneurysms has been aneurysm which was contiguous to the superior mesenteric artery (SMA) (Figures 1A-C). A detailed chart review was performed for all patients undergoing EMBO. Crossref, Medline, Google Scholar; 36 Iwase K, Higaki J, Mikata S, et al. Fusiform true aneurysms are better treated with a stent graft (covered stent), while tortuous, saccular aneurysms are treated with aneurysmal coiling techniques.Pseudoaneurysms can be treated with embolization using liquid embolic agents to thrombose the inflow and outflow arteries or filling the sac itself. The effects of splenic artery embolization on nonoperative mangement of blunt splenic injury: a 16-year experience. The celiac trunk is engaged using a 5 Fr reverse curve catheter, such as a Cobra, Sos or Simmons catheter. However, both splenectomy and splenic artery embolization can lead to splanchnic vein thrombosis (SVT), which is life-threatening [7,8,9]. Over time, aneurysms may grow. Preventive proximal splenic artery embolization should be performed in high-risk patients (ie, patients > 50 years, those with an intraperitoneal bleed, and those scheduled for prolonged surgery for other reasons). Abdominal Doppler ultrasonography and enhanced . This is a re-sult of the expansion of a stem cell clone with an acquired mutation in the PIG-A gene [1], resulting in defective The larger the aneurysm, the more dangerous it can be. However, the optimal embolization techniques are still inconclusive. Partial splenic embolization , pse : 5. Seven years later, transcatheter partial splenic embolization (PSE) was developed by Spigos et al. After delineating the vital normal vessels to the pancreas into the stomach, the distal to mid splenic artery was embolized using a total of 10 platinum microcoils ranging from 8 mm to 10 mm in size. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Gastric variceal bleeding due to splenic vein thrombosis is a life-threatening situation and is often difficult to manage by endoscopy. In the worst cases, an emergency splenectomy may be required to stop variceal . PDF | Capecitabine and oxaliplatin (CAPOX) plus bevacizumab (BEV) therapy (CAPOX/BEV) is a standard treatment recommended as the first-line treatment. SAE provides patients with a quick, minimally invasive treatment for acute splenic hemorrhage., However, there is varying data on the outcomes of these patients with regard to technical factors. Splenic artery embolization: have we gone too far? We conclude that SAE can be a safe and effective treatment option for HDU patients with ASI, including high-grade splenic injury. Article Google Scholar Capecci LM, Jeremitsky E, Smith RS, Philp F. Trauma centers with higher rates of angiography have a lesser incidence of splenectomy in the management of blunt splenic injury. A three-dimensional CT care settings by general surgeons with good results (4). Splenic preservation rates are improved for participants with high-grade splenic injuries (defined as Grade III-V injuries by the American Association for the Surgery of Trauma (AAST) guidelines) when non-operative management is supplemented by image-guided, trans-catheter splenic artery embolization (SAE). Please Splenic embolization. Keywords: blunt splenic trauma, hypersplenism, splenic embolization. Management of splenic injury depends on the clinical status of the patient and can include nonoperative management (NOM), splenic artery embolization (SAE), surgery (operative splenic salvage or splenectomy), or a combination of these treatments. 2015;158:1020-4-6. Compared with splenectomy, PSE is less invasive and can be performed with short-term interruption of chemotherapy. Splenic artery embolization is based on the clinical and imaging findings. In addition, nine interlock coils (Boston Scientific GmbH) were introduced in order to create a . Between June 2004 and June 2010, 6 patients underwent proximal SAE for RA. Surgery. The majority of patients show no signs or symptoms [].The exact cause of a splenic artery aneurysm is uncertain, while its combination with the possibility of rupture, can result in a clinical picture ranging from nonspecific abdominal symptoms (making prerupture . This includes antibiotic prophylaxis (e.g., cefazolin 1 g; 12 hours before and 1 to 2 weeks after the procedure), additional local antibiotics (e.g., gentamicin) applied with the embolic solution. Splenic ( artery) embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. A Novel Case of Delayed Splenic Rupture after Intervetional Arterial Embolization for Patients with Spleen-Kidney Blunt Injury January 2022 DOI: 10.51737/2766-4589.2022.053 Discussion. 15 years of age 2. The procedure was well tolerated without complications, and immediately post-embolization our patient's platelet count improved to 26 K/mcL. Splenic artery embolization before laparoscopic splenectomy: an update. a Splenectomy or Splenic Embolization . Transcatheter splenic artery embolization has a major role in the management of traumatic splenic injuries and as an adjunctive procedure in the treatment of thrombocytopenia and portal hypertension. Background: Splenic artery angioembolization (EMBO) has been promoted to increase the success rate of nonoperative management of splenic injuries. Splenic preservation rates are improved for participants with high-grade splenic injuries (defined as Grade III-V injuries by the American Association for the Surgery of Trauma (AAST) guidelines) when non-operative management is supplemented by image-guided, trans-catheter splenic artery embolization (SAE). Until now, the epidemiology of and risk factors for SVT . 5. For splenic artery embolization, in 1979, Spigos et al. and those undergoing splenic artery EMBO between January 2000 through June 2004. K. Farsad receives research from Guerbet and Terumo and honoraria . Surg Endosc 1998;12:870-875. This survey demonstrates that there is lack of consensus and wide variability in the UK IR community as to the best application of splenic embolisation in the acute traumatic setting; however, this appears to be due to a lack of clear evidence and . A splenic artery aneurysm is usually single and isolated and is 3 cm in size, whereas giant aneurysms (diameter 10 cm) are rare. In a hemodynamically stable patient, contrast extravasation, presence of pseudoaneurysm or arteriovenous fistula, decreasing hematocrit, active contrast extravasation, AAST III grade or higher injury and large hemorrhagic ascites are indicators for urgent angiography and . 2 A preponderance of stab . Splenic artery embolization has been used as an adjunct to nonsurgical treatment of blunt splenic injuries. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Splenic artery embolization (SAE) was performed in these two patients for reducing portal hypertension by diminishing left-sided blood flow in the portal venous system. Computed angiotomography was done within the first month and magnetic resonance angiography (MRA) after 6 and 12 months, then yearly. The splenic artery embolization was completed using a 12-mm Amplatzer II plug, which successfully slowed the blood flow to the middle and distal parts of the splenic artery (Figures 2 and 3). Post-splenic artery embolization Splenic irradiation 50% Sickle cell disease Page 1 of 6 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson's specific patient population, services and structure, and clinical information.