SPLEnic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study.
Embolization
Hemorrhage
SAE
Spleen
Trauma
Journal
CVIR endovascular
ISSN: 2520-8934
Titre abrégé: CVIR Endovasc
Pays: Switzerland
ID NLM: 101738484
Informations de publication
Date de publication:
07 Dec 2020
07 Dec 2020
Historique:
received:
21
10
2020
accepted:
29
11
2020
entrez:
7
12
2020
pubmed:
8
12
2020
medline:
8
12
2020
Statut:
epublish
Résumé
As an adjunct to non-operative management, splenic artery embolization (SAE) has been increasingly utilized throughout the world and is now the standard of care for hemodynamically stable patients. This study aimed to retrospectively assess the rate of splenic salvage and complications after SAE for blunt trauma at a level 1 trauma center using the 2018 update to the AAST criteria, and further sub-stratify the role of angiography in AAST grade III injuries with significant hemoperitoneum. All patients between 1 January 2009 and 1 January 2019 who underwent blunt trauma and proceeded to embolization were included. Data was collected concerning initial injury grade, location of embolization, type of embolic material used, complications, and need for subsequent splenectomy. Technical success was defined as successful angiographic occlusion of the target artery at the conclusion of embolization. Clinical success was defined as splenic salvage at discharge. Vascular lesions were characterized including those with active bleeding, pseudoaneurysm, and arterio-venous fistula. Two hundred thirty-two patients were included in the study. Treatments were performed at a median of 0 days (range 0-28 days) and the median AAST grade was IV (range III-V). Technical success was achieved in all patients. There were 13 complications (5.6%) consisting of re-bleed (9, 3.9%), infarction (3, 1.3%), and access site haematoma (1, 0.43%). Clinical success was achieved in 97% of patients with 7 patients requiring splenectomy after SAE (3.0%) at a median time of 4 days (range 0-17 days). Angiography in patients with grade III injuries identified 18 occult vascular injuries not identified at initial CT (p < 0.0001). The SPLEEN-IN study shows that treatment of intermediate-high grade blunt force traumatic splenic injuries using SAE resulted in a low rate of complication and splenic salvage in 97% of patients, providing a safe and effective treatment in stable patients. In addition, angiography of grade III injuries identified occult vascular lesions and may warrant treatment of select patients in this cohort. Level 3.
Sections du résumé
BACKGROUND
BACKGROUND
As an adjunct to non-operative management, splenic artery embolization (SAE) has been increasingly utilized throughout the world and is now the standard of care for hemodynamically stable patients. This study aimed to retrospectively assess the rate of splenic salvage and complications after SAE for blunt trauma at a level 1 trauma center using the 2018 update to the AAST criteria, and further sub-stratify the role of angiography in AAST grade III injuries with significant hemoperitoneum. All patients between 1 January 2009 and 1 January 2019 who underwent blunt trauma and proceeded to embolization were included. Data was collected concerning initial injury grade, location of embolization, type of embolic material used, complications, and need for subsequent splenectomy. Technical success was defined as successful angiographic occlusion of the target artery at the conclusion of embolization. Clinical success was defined as splenic salvage at discharge. Vascular lesions were characterized including those with active bleeding, pseudoaneurysm, and arterio-venous fistula.
RESULTS
RESULTS
Two hundred thirty-two patients were included in the study. Treatments were performed at a median of 0 days (range 0-28 days) and the median AAST grade was IV (range III-V). Technical success was achieved in all patients. There were 13 complications (5.6%) consisting of re-bleed (9, 3.9%), infarction (3, 1.3%), and access site haematoma (1, 0.43%). Clinical success was achieved in 97% of patients with 7 patients requiring splenectomy after SAE (3.0%) at a median time of 4 days (range 0-17 days). Angiography in patients with grade III injuries identified 18 occult vascular injuries not identified at initial CT (p < 0.0001).
CONCLUSIONS
CONCLUSIONS
The SPLEEN-IN study shows that treatment of intermediate-high grade blunt force traumatic splenic injuries using SAE resulted in a low rate of complication and splenic salvage in 97% of patients, providing a safe and effective treatment in stable patients. In addition, angiography of grade III injuries identified occult vascular lesions and may warrant treatment of select patients in this cohort.
LEVEL OF EVIDENCE
METHODS
Level 3.
Identifiants
pubmed: 33283253
doi: 10.1186/s42155-020-00185-4
pii: 10.1186/s42155-020-00185-4
pmc: PMC7719586
doi:
Types de publication
Journal Article
Langues
eng
Pagination
92Références
Injury. 2020 Sep 19;:
pubmed: 32962832
Tech Vasc Interv Radiol. 2007 Dec;10(4):257-60
pubmed: 18572138
J Trauma. 2011 Jan;70(1):252-60
pubmed: 21217497
Cardiovasc Intervent Radiol. 2017 Aug;40(8):1141-1146
pubmed: 28584945
Ann R Coll Surg Engl. 2018 Aug 16;:1-7
pubmed: 30112955
Cardiovasc Intervent Radiol. 2021 Jan;44(1):167-169
pubmed: 32875434
Med J Aust. 2008 Nov 17;189(10):546-50
pubmed: 19012550
Injury. 2017 May;48(5):1031-1034
pubmed: 28292519
J Trauma. 1989 Dec;29(12):1664-6
pubmed: 2593197
Diagn Interv Imaging. 2015 Jul-Aug;96(7-8):687-91
pubmed: 26119866
World J Surg. 2019 May;43(5):1216-1225
pubmed: 30610269
J Trauma Acute Care Surg. 2017 Sep;83(3):356-360
pubmed: 28459796
Injury. 2016 Mar;47(3):525-30
pubmed: 26772452
CVIR Endovasc. 2019 Mar 18;2(1):11
pubmed: 32026033
Mil Med Res. 2017 May 30;4:17
pubmed: 28573044
Semin Intervent Radiol. 2020 Mar;37(1):97-102
pubmed: 32139975
J Trauma Acute Care Surg. 2018 Dec;85(6):1119-1122
pubmed: 30462622