Therapeutic strategies for pseudoaneurysm following blunt liver and spleen injuries: A multicenter cohort study in the pediatric population.

Humans Child Spleen / injuries Aneurysm, False Retrospective Studies Liver / injuries Wounds, Nonpenetrating / therapy Disease Progression Treatment Outcome

Journal

The journal of trauma and acute care surgery

ISSN: 2163-0763

Titre abrégé: J Trauma Acute Care Surg

Pays: United States

ID NLM: 101570622

Informations de publication

Date de publication:
01 03 2023

Historique:

pubmed: 18 10 2022

medline: 25 2 2023

entrez: 17 10 2022

Statut: ppublish

Résumé

Little guidance exists for the treatment of pseudoaneurysm (PA) following pediatric blunt liver and/or spleen injuries (BLSIs). We aimed to describe the incidence of delayed PA development and the subsequent clinical course of PA in pediatric BLSIs. This multicenter retrospective cohort study from Japan included pediatric patients (16 years and younger) who sustained BLSIs from 2008 to 2019. The cohort was divided into four groups based on hemostatic intervention within 48 hours of admission, namely, nonoperative management (NOM), NOM with interventional radiology (IR), operative management (OM), and combined IR/OM. Descriptive statistics were used to describe the incidence of delayed PA among the groups and to characterize the clinical course of any PAs. A total of 1,407 children (median age, 9 years) from 83 institutions were included. The overall number (incidence) of cases of delayed PA formation was 80 (5.7%), and the number with delayed PA rupture was 16 cases (1.1%) in the entire cohort. Patients treated with NOM (1,056), NOM with IR (276), OM (53), and combined IR/OM (22) developed 43 (4.1%), 32 (12%), 2 (3.8%), and 3 (14%) delayed PAs, respectively. Among patients who developed any PAs, 39% of patients underwent prophylactic IR for unruptured PA, while 13% required emergency angioembolization for delayed PA rupture, with one ruptured case requiring total splenectomy. At least 45% of patients experienced spontaneous resolution of PA without any interventions. Our results suggest that the risk of delayed PA still exists even after acute phase IR as an adjunct to NOM for BLSIs in children, indicating the necessity of a period of further observation. While endovascular interventions are usually successful for PA management, including rupture cases, given the high incidence of spontaneous resolution, the ideal management of PA remains to be investigated in future studies. Therapeutic/Care Management; Level IV.

Sections du résumé

BACKGROUND

METHODS

This multicenter retrospective cohort study from Japan included pediatric patients (16 years and younger) who sustained BLSIs from 2008 to 2019. The cohort was divided into four groups based on hemostatic intervention within 48 hours of admission, namely, nonoperative management (NOM), NOM with interventional radiology (IR), operative management (OM), and combined IR/OM. Descriptive statistics were used to describe the incidence of delayed PA among the groups and to characterize the clinical course of any PAs.

RESULTS

A total of 1,407 children (median age, 9 years) from 83 institutions were included. The overall number (incidence) of cases of delayed PA formation was 80 (5.7%), and the number with delayed PA rupture was 16 cases (1.1%) in the entire cohort. Patients treated with NOM (1,056), NOM with IR (276), OM (53), and combined IR/OM (22) developed 43 (4.1%), 32 (12%), 2 (3.8%), and 3 (14%) delayed PAs, respectively. Among patients who developed any PAs, 39% of patients underwent prophylactic IR for unruptured PA, while 13% required emergency angioembolization for delayed PA rupture, with one ruptured case requiring total splenectomy. At least 45% of patients experienced spontaneous resolution of PA without any interventions.

CONCLUSION

Our results suggest that the risk of delayed PA still exists even after acute phase IR as an adjunct to NOM for BLSIs in children, indicating the necessity of a period of further observation. While endovascular interventions are usually successful for PA management, including rupture cases, given the high incidence of spontaneous resolution, the ideal management of PA remains to be investigated in future studies.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.

Identifiants

DOI: 10.1097/TA.0000000000003813 PMID: 36245083

pubmed: 36245083

doi: 10.1097/TA.0000000000003813

pii: 01586154-202303000-00011

doi:

Banques de données

UMIN-CTR

['UMIN000041296']

Types de publication

Multicenter Study Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

433-442

Investigateurs

Tomoya Ito (T)

Motoyoshi Yamamoto (M)

Yoshihiro Yamamoto (Y)

Hiroto Manase (H)

Nozomi Takahashi (N)

Akinori Osuka (A)

Suguru Annen (S)

Nobuki Ishikawa (N)

Kazushi Takayama (K)

Keita Minowa (K)

Kenichi Hakamada (K)

Akari Kusaka (A)

Mineji Hayakawa (M)

Shota Kawahara (S)

Satoshi Hirano (S)

Marika Matsumoto (M)

Kohei Kusumoto (K)

Hiroshi Kodaira (H)

Chika Kunishige (C)

Keiichiro Toma (K)

Yusuke Seino (Y)

Michio Kobayashi (M)

Masaaki Sakuraya (M)

Takafumi Shinjo (T)

Shigeru Ono (S)

Hideto Yasuda (H)

Haruka Taira (H)

Kazuhiko Omori (K)

Yutaka Kondo (Y)

Yoshio Kamimura (Y)

Atsushi Shiraishi (A)

Rei Tanaka (R)

Yukihiro Tsuzuki (Y)

Yukio Sato (Y)

Noriaki Kyogoku (N)

Masafumi Onishi (M)

Kaichi Kawai (K)

Kazuyuki Hayashida (K)

Keiko Terazumi (K)

Akira Kuriyama (A)

Susumu Matsushime (S)

Osamu Takasu (O)

Toshio Morita (T)

Nagato Sato (N)

Wataru Ishii (W)

Michitaro Miyaguni (M)

Shingo Fukuma (S)

Yosuke Nakabayashi (Y)

Yoshimi Ohtaki (Y)

Kiyoshi Murata (K)

Masayuki Yagi (M)

Tadashi Kaneko (T)

Shigeru Takamizawa (S)

Akihiro Yasui (A)

Yasuaki Mayama (Y)

Masafumi Gima (M)

Ichiro Okada (I)

Asuka Tsuchiya (A)

Koji Ishigami (K)

Yukiko Masuda (Y)

Yasuo Yamada (Y)

Hiroshi Yasumatsu (H)

Kenta Shigeta (K)

Kohei Kato (K)

Fumihito Ito (F)

Atsuyoshi Iida (A)

Tetsuya Yumoto (T)

Hiromichi Naito (H)

Morihiro Katsura (M)

Yoshitaka Saegusa (Y)

Tomohiko Azuma (T)

Shima Asano (S)

Takehiro Umemura (T)

Norihiro Goto (N)

Takao Yamamoto (T)

Junichi Ishikawa (J)

Elena Yukie Uebayashi (EY)

Shunichiro Nakao (S)

Yuko Ogawa (Y)

Takashi Irinoda (T)

Yuki Narumi (Y)

Miho Asahi (M)

Takayuki Ogura (T)

Takashi Hazama (T)

Shokei Matsumoto (S)

Daisuke Miyamoto (D)

Keisuke Harada (K)

Narumi Kubota (N)

Yusuke Konda (Y)

Takeshi Asai (T)

Tomohiro Muronoi (T)

Kazuhide Matsushima (K)

Toru Hifumi (T)

Kasumi Shirasaki (K)

Shigeyuki Furuta (S)

Atsuko Fujikawa (A)

Makoto Takaoka (M)

Kaori Ito (K)

Satoshi Nara (S)

Shigeki Kushimoto (S)

Atsushi Tanikawa (A)

Masato Tsuchikane (M)

Naoya Miura (N)

Naoki Sakoda (N)

Tadaaki Takada (T)

Shogo Shirane (S)

Akira Endo (A)

Keita Nakatsutsumi (K)

Kenta Sugiura (K)

Yusuke Hagiwara (Y)

Tamotsu Gotou (T)

Informations de copyright

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