2 ), the microcatheter is placed as distally as possible in the injured splenic artery branches before embolization to preserve as much of the spleen as possible. A splenic artery aneurysm is a bulging, weakened section of the artery that supplies blood to your spleen and parts of your pancreas and stomach. Distal embolization can be used in cases of focal injury. Intervention Name: Splenic artery embolization with vascular embolic coils or plugs. Management by coiling of the splenic artery aneurysm and embolization to the entire segment distal to it was successfully performed for this patient. Many people have no symptoms, but a common symptom is pain in the upper left side of your belly. 5. Two 6 mm and one 8 mm coils were placed in the splenic artery. 15 years of age 2. . . La Biblioteca Virtual en Salud es una coleccin de fuentes de informacin cientfica y tcnica en salud organizada y almacenada en formato electrnico en la Regin de Amrica Latina y el Caribe, accesible de forma universal en Internet de modo compatible con las bases internacionales. Risk factors for aneurysm formation and rupture include pregnancy and portal hypertension. What is the treatment for splenic artery aneurysm? Proximal splenic artery embolization decreases the perfusion pressure in the spleen but allows for viability of the spleen to be maintained via collateral pathways. Absorbable gelatin (Upjohn), particles (300-500 mm), or coils can be used either alone or in combination. The catheter was then pulled back to the mid-splenic artery. Additionally, patient . Embolization of a brach distal to the aneurym was performed with multiple steel coils. splenic perfusion is maintained via a collateral pathway consisting of flow from the splenic artery proximal to the site of embolization through the smaller dorsal pancreatic artery to the transverse pancreatic artery to the pancreatica magna artery which then delivers a slower, smaller amount of blood to the splenic artery distal to the site of Angiogram before (A) and after coiling (B). 10 (October 1, 2020): 1570 . Splenic artery aneurysms (SAA) are the third most common type of arterial aneurysm, with diameters ranging from 0.6 to 30 cm. Purpose: To assess clinical outcomes of blunt splenic injuries (BSI) managed with proximal versus distal versus combined splenic artery embolization (SAE). Biliary tract injuries can be difficult to diagnose and require either an . Current data favor the use of proximal and coil . The proximal part. (E) Splenic artery reconstruction using 5-0 prolene. Proximal splenic artery embolization for splenic trauma can be satisfactorily achieved with either vascular plugs or endovascular coils with no differences in splenic salvage or complication rates in this retrospective study. The main splenic artery embolization was performed on the line segment (about 2mm) Fig. . CONCLUSION. Embolization (in this study) transiently elevates the WBC count, but it then drops back to normal. Isolated SAD is extremely rare but life-threatening [ 2 ]. Splenic artery embolization was successfully performed in all patients in group 1. [5,6] It is usually located in the mid or distal portion of the splenic artery, frequently at an arterial bifurcation. Purpose: To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Splenic artery embolization (SAE) is the preferred treatment for a bleeding SAP. Lee, Rang, Chang Ho Jeon, Chang Won Kim, Hoon Kwon, Jae Hun Kim, Hohyun Kim, Sung Jin Park, Gil Hwan Kim, and Chan Yong Park. Background The mean post procedure peak platelet count was 209x109 /L, increased from an average of 45x109 /L (p<0.01.) Splenic infarcts can result following a SAE. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Proximal splenic artery embolization (PSAE) In PSAE, embolization is performed distal to the dorsal pancreatic artery. . Distal splenic artery embolization leads to occlusion of smaller segmental branches. Splenic artery dissection (SAD) usually originates from dissection of the celiac trunk or the abdominal aorta [ 1 ]. The distal splenic artery was cannulated through the lumen of the aneurysm. Materials and methods: All consecutive patients with BSI admitted to our trauma centre from 2005 to 2010 and managed with SAE were reviewed. Keywords: blunt splenic trauma, hypersplenism, splenic embolization. Download Citation | On Jul 1, 2011, Douglas B Paul and others published Proximal Splenic Arterial Embolization May Also Result in Pancreatic Necrosis | Find, read and cite all the research you . DSA = distal splenic artery, M = monitor, PSA = proximal splenic artery, SA = splenic artery, SAA = splenic artery aneurysm, Sp = spleen, St = stomach. Because these branches are end arteries, the risk for parenchymal wedge infarction or abscess formation may increase. The difference in the increasing length of the artery and the distance between its origin and the splenic hilum makes the artery tortuous. (CD) complications, one of which required to be reoperated for a hematoma after splenic artery embolization, and the other . Pseudoaneurysms can be treated with embolization using liquid embolic agents to thrombose the inflow and . The celiac trunk, hepatic artery, splenic artery, and superior mesenteric artery were selectively catheterized. Medical Information Search. A recent meta-analysis evaluating the outcomes of proximal versus distal splenic artery embolization demonstrated increased complications, such as splenic infarction, after distal embolization. posted on 01.12.2020, 00:00 authored by E Leung, Julian Maingard Julian Maingard, J Yeh, M J Lee, D M Brooks, Hamed Asadi Hamed Asadi, D A Burrows, Terry Kok. A Biblioteca Virtual em Sade uma colecao de fontes de informacao cientfica e tcnica em sade organizada e armazenada em formato eletrnico nos pases da Regio Latino-Americana e do Caribe, acessveis de forma universal na Internet de modo compatvel com as bases internacionais. Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. Trauma resulting in grade III or higher splenic injury on contrast-enhanced CT 3. KAP/BMI was also used as a surrogate marker to account for differences in body habitus. #{149} Spleen, flow arteries that initially were and continued emboliza- Radiology 1985; 154: 245 lion could occlude these . Selective catheterization of the distal branches of the splenic artery was performed with a microcatheter (3rd order branch) measuring 2. Splenic artery embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. The spleen is the most commonly injured organ after blunt abdominal trauma. 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. 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 . Description: Splenic artery embolization with vascular embolic coils or plugs Eligibility: Criteria: Inclusion Criteria: 1. 9 These results demonstrate the importance of performing the coil embolization in a proximal location for this particular . It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Mean operating time was 178 min. Distal embolization (curative) of distal arterial bleeding using a microcatheter. Materials and methods: Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. English Espaol Portugus Franais Italiano Svenska . Splenic artery aneurysm (arrows) partially calcified and thrombosed by computed tomography angiography on (A) axial slice and (B) double oblique multiplanar reconstruction showing proximal and distal end of vessel. ( 1, 2) However, the effect of PSE on portal pressure is secondary to the induction of splenic infarction. The spleen is the most commonly injured organ in blunt abdominal trauma. For distal splenic artery embolization ( Fig. The big problem with this study (besides it being small) is that it fails to recognize that there are many different shades of embolization. Since the early 1970s several studies have reported distal splenic artery embolization, better known as partial spleen embolization (PSE), as an efficacious treatment of portal hypertensive variceal bleeding and hypersplenism in cirrhosis. Distal embolisations were defined as occlusion of a branch distal to the main splenic artery. It was then keenly monitored primarily focusing on the vital signs perioperatively; as . Nonoperative management with splenic arterial embolization (SAE) is the current standard of care for hemodynamically stable patients. Different studies examining SAE vary in their definitions of major and minor complications. Cite Share. 2012;29(2):147-9. . True splenic artery aneurysms (SAAs) involve all layers of the wall, each of which is intact and thinning. Pooled outcomes were compared between proximal and distal embolizations. OSTI.GOV Journal Article: Proximal Embolization of the Splenic Artery with a Penumbra Occlusion Device (POD): A Novel Occlusion Technique for Blunt Splenic Injuries The other 20 patients had a vascular injury demonstrated on angiography: 12 pseudoaneurysm +/- arteriovenous fistula, 1 abnormal truncated artery, 7 extravasation. However, the optimal embolization techniques are still inconclusive. Distal splenic artery embolization (DSAE) Superselective distal embolization. Introduction The splenic artery is the third most common artery affected by an aneurysm following aorta and iliac arteries and it accounts for nearly all cases of visceral artery aneurysms. Because these branches are end arteries, the risk for parenchymal wedge infarction or abscess formation may increase. To date, only eight cases with isolated SAD have been reported in literature and six (75%) had dissection rupture. English. This is considered a distal splenic artery embolization because the embolization occurred beyond the splenic hilum and distal to any major potential collateral pathways. This study compared proximal and distal embolization of the splenic artery (SA) in patients with splenic artery steal syndrome (SAS) after orthotopic liver transplantation (OLT) regarding post interventional changes of liver function to identify an ideal location of embolization. Two widely used embolization approaches are proximal and distal splenic artery embolization. "Clinical Results of Distal Embolization in Grade V Splenic Injury: Four-Year Experience from a Single Regional Trauma Center.". Two patients with small pseudoaneurysms were not embolized, and 9 were treated with distal splenic artery embolization +/- distal branch embolization; all 11 patients did well. splenic perfusion is maintained via a collateral pathway consisting of flow from the splenic artery proximal to the site of embolization through the smaller dorsal pancreatic artery to the transverse pancreatic artery to the pancreatica magna artery which then delivers a slower, smaller amount of blood to the splenic artery distal to the site of