Arterial embolization of the spleen may have two different objectives. At mount sinai hospital in new york city, interventional radiologists, dr. The use of splenic artery embolization to maintain adequate hepatic arterial inflow after hepatic artery thrombosis in a split liver transplant recipient. Splenic vascular anatomy the splenic artery supplies the spleen and substantial portions of the stomach and pancreas fig 1 1. History of splenic embolization for ph tn 19731 first report of complete splenic embolization autologous clot used to embolize the spleen of a farmer with recurrent esophageal variceal bleeding subsequent cases major complications abscess, septic shock, splenic rupture 19792 suggested limited embolization 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. Nonoperative management and failure rates as they have changed over the study period are demonstrated in table 4. Listing a study does not mean it has been evaluated by the u. Examine the usefulness of splenic artery embolization and compare it with surgery for patients with actively bleeding spleen injuries recognize the complications following embolization of the spleen and compare them with complications of splenectomy. Benefit of prophylactic embolization of the splenic salvage. Thus, the risks and potential benefits of splenic artery embolization sae were explained to the patient and her husband, and informed consent was obtained for the procedure. Outcomes of proximal versus distal splenic artery embolizati. Splenic artery embolization as an adjunctive procedure for. Stentsupported coil embolization of a splenic artery aneurysm. We feel splenic artery embolisation is a good treatment for variceal bleeding for elective cases, though in emergency, initial sclerotherapy still remains the first line of treatment.
A femoral artery approach is used for selective catheterization of the splenic artery. Partial splenic artery embolization in cirrhotic patients. Splenic embolization procedure answers on healthtap. For procedure planning, celiac and splenic artery anatomy should be evaluated on contrastenhanced ct images, including two and threedimensional formats, to help determine a vascular access route and choose adequate materials for either proximal or distal splenic artery embolization. This study was conducted to assess the safety and efficacy of pse compared to. Embolization for splenic trauma endovascular today.
The main splenic artery is then catheterized and a splenic arteriogram performed. Dec 23, 2015 arterial embolization of the spleen may have two different objectives. Mar 01, 2014 followup embolization angiography is included in the new embolization codes. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and. We present a case of acute necrotizing pancreatitis after splenicartery embolization for acute splenic injury. Single port surgery uses a special port that multiple instruments go through, unlike traditional laparoscopy where each port canfield only one instrument. To determine the impact of coil embolization of the splenic artery on splenic volume based on computed tomography ct imaging. Massive gastrointestinal bleeding may result either from esophageal gastric varices or from portal hypertensive gastropathy. Fourteen patients had evidence of pseudoaneurysms on angiography, of whom four 29% failed. In recent years, partial splenic embolization pse has been widely used in patients with hypersplenism and cirrhosis. Splenic artery embolisation for portal hypertention in. Benefit of prophylactic embolization of the splenic salvage splash the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Here, we report the case of a 56yearold man diagnosed with massive splenomegaly, secondary to a marginal splenic lymphoma, which had a maximum diameter of 54 cm. A secondary aim is to evaluate the relative efficacy of two separate splenic artery embolization techniques, coiling versus particle embolization of the spleen.
Nonoperative management of unruptured visceral artery aneurysms. The increased susceptibility of patients to infections after splenectomy has led to the use of splenic preservation procedures 4, 5. Gastric variceal bleeding due to splenic vein thrombosis is a lifethreatening situation and is often difficult to manage by endoscopy. Current and future research topics also are discussed. Splenic and renal embolization amazon web services.
Proximal splenic artery embolization, via deployment of coils or an amplatzer plug in the splenic artery immediately distal to the pancreatic and short gastric arteries, has been established as a safe and effective option in the nonsurgical management of sass3942. Gastric variceal bleeding is a lifethreatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Splenic artery embolization for massive splenomegaly. Massive variceal bleeding secondary to splenic vein. It was first described in 1981 by sclafani 3 and became more widely used in the late 1990s. In the worst cases, an emergency splenectomy may be required to stop variceal bleeding. The splenic artery courses superior and anterior to the splenic vein, along the superior edge of the pancreas. Uterine artery embolization for leiomyomas and adenomyosis. Sinistral portal hypertension sph is a clinical syndrome of gastric variceal hemorrhage in the setting of splenic vein thrombosis svt, mostly due.
Microcatheters were introduced and distal selective embolization of the pseudoaneurysm was performed using coils. Role of splenic artery partial embolization in a patient with. Generally, the catheter tip is placed as distally as possible in an intrasplenic artery. Splenic artery embolization is used after splenic trauma topreserve the splenic parenchyma but its efficacy is unproven.
The combination of thrombosis, splenomegaly, and thrombocytopenia tst is challenging because anticoagulants are indicated but thrombocytopenia may increase the bleeding risk. Ikeda o, tamura y, nakasone y, iryou t, yamashita y. A patient presents with significant hemorrhage secondary to the rupture of a splenic artery aneurysm. Splenic artery embolization has been used as an adjunct to nonsurgical treatment of blunt splenic injuries. Splenic artery embolization in a woman with bleeding gastric. The primary purpose of this study is to evaluate the safety and efficacy of partial splenic artery embolization in the treatment of symptomatic portal vein hypertension. Efficacy and surgical procedures of preoperative splenic. Ideally, the splenic artery should be occluded in its middle segment. Pdf the use of splenic artery embolization to maintain. Splenic vein thrombosis is a relatively common finding in pancreatitis.
Splenic artery angioembolization embo has been promoted to increase the success rate of nonoperative management of splenic injuries. We report the case of a 60yearold caucasian woman with bleeding gastric varices secondary to splenic vein thrombosis treated by splenic artery embolization. Depending on the aim of the procedure, splenic embolization may be considered an alternative to either splenectomy or ligation of the splenic artery. However, the operation may be hazardous in patients with poor liver function. Selective distal embolization failed in 33% of the cases compared with main splenic artery failure rate of 22%. Transradial embolization of a large splenic artery.
Splenectomy could alleviate thrombocytopenia and reduce portal pressure, but it can cause postoperative thromboses and. Splenic embolization in nontraumatized patients radiology key. Aaron fischman perform transradial access for embolization of a large splenic artery pseudoaneurysm. In addition, major requiring splenectomy or minor not requiring splenectomy rebleeding, infarction, and infection in relation to the site of. Management of splenic injury depends on the clinical status of the patient and can include nonoperative management nom. Laparoscopically assisted splenectomy following preoperative splenic artery embolization using contour emboli for myelofibrosis with massive splenomegaly. A splenic artery embolization can be performed before the surgery, in order to decrease both the size of the spleen and the risk of bleeding. Mar 27, 2014 pnh is associated with abdominal vein thrombosis, which can cause splenomegaly and hypersplenism. Other options include embolization of the aneurysm sac with coils or cyanoacrylate glue or both modalities simultaneously or occlusion of the lesion with percutaneous or open thrombin. Prostate artery embolization the university health network.
Treatment options include coil embolization of the splenic artery both proximal and distal to the aneurysm itself, thereby effectively trapping the lesion. Splenic embolization for portal hypertension full text view. Selective splenic artery embolization for the treatment of. Splenic artery embolization is an endovascular technique for treatment of splenic and splenic artery pathology as an alternative to splenic artery ligation or splenectomy. In nonoperatively managed cases, sae is sometimes used to control. Traditionally, splenectomy is considered the treatment of choice. Splenectomy could alleviate thrombocytopenia and reduce portal pressure, but it can cause post. Acute necrotizing pancreatitis following splenic artery. Splenic artery aneurysm saa is an uncommon and difficult diagnosis. Embolization of the uterine arteries has been the standard.
A bronchialartery embolisation bae is a procedure where. Aug 19, 2015 at mount sinai hospital in new york city, interventional radiologists, dr. Complications arising from splenic embolization after blunt. On completion of this article, the reader will be able to define the role of splenic artery embolization in the treatment of portal hypertension including the indications, technical considerations, outcomes, and complications. Proximal splenic artery embolization, via deployment of coils or an amplatzer plug in the splenic artery immediately distal to the pancreatic and short gastric arteries, has been established as a safe and effective option in the nonsurgical management of sass 3942. Hypersplenism occurs in patients with chronic liver disease, and splenectomy is the definitive treatment. A specially trained doctor called an interventional radiologist will inject small particles through the blood stream and block the blood flowing to the arteries large. Here, we report the case of a 56yearold man diagnosed with massive splenomegaly, secondary to a marginal splenic lymphoma, which had a. Consider new interventional radiology coding concepts aapc.
Methods twoyear retrospective trauma quality improvement program database prognostic study. Majercik, md, jeff jednacz, md, robert lambiase, md, and william g. Went did several,angiograms,via cannulation,of right common femoral artery,cannulation,of the aorta, via the iliac system. Preoperative splenic artery embolization was used in 26 of 54 patients 48% undergoing laparoscopic splenectomy. Once bleeding is under control, splenic artery embolisation can be done effectively as was shown in our series. Pdf splenic liquefaction after splenic artery embolization. Splenic artery embolization for the treatment of gastric. 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. This study was conducted to assess the safety and efficacy of pse compared to splenectomy in. A decision wasmade at that time to proceed with embolization hoping to avoidsurgical intervention. Followup embolization angiography is included in the new embolization codes. Aug 30, 2014 aneurysms of an aberrant splenic artery originating from the superior mesenteric artery sma are extremely rare. The spleen is the second most commonly injured organ in cases of abdominal trauma.
The process is repeated in your other uterine artery for complete blockage of blood flow to the fibroid. Bronchialartery embolisation oxford university hospitals. Tufts university school of medicine is accredited by the accreditation council for continuing medical education to provide continuing medical. Pancytopenia treatment by splenic artery embolisation. If a distal embolization procedure is to be performed, a microcatheter and wire combination e. Partial splenic embolization, hepatology research 10. Xrays are used to examine the bronchial arteries arteries in your lung. Stainless steel coils embolization has less emboliza. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm group i, except the first two 1820. Angiographic embolization of a posttraumatic splenic. Aneurysms of an aberrant splenic artery originating from the superior mesenteric artery sma are extremely rare. We present a case of a male patient with a bleeding saa that rapidly increased in size. Boston scientific, natick, ma are placed as distally and near to the injured vessel as possible.
Partial splenic embolization versus splenectomy for the. Review article clinical application of partial splenic. Splenic artery embolization before laparoscopic splenectomy. Pnh is associated with abdominal vein thrombosis, which can cause splenomegaly and hypersplenism. It often results in successfully treating the underlying pathology, while maintaining at least partial splenic function. Sep, 2016 the spleen is the second most commonly injured organ in cases of abdominal trauma. History of splenic embolization for ph tn 19731 first report of complete splenic embolization autologous clot used to embolize the spleen of a farmer with recurrent esophageal variceal bleeding subsequent cases major complications abscess, septic shock, splenic rupture 19792 suggested limited embolization background. Uterine fibroid embolization ufe is a minimally invasive procedure used to treat fibroid tumors of the uterus which can cause heavy menstrual bleeding, pain. Intraoperative sae was performed with a continuous splenic arterial infusion of epinephrine 0.
Since its introduction in 1995, uterine artery embolization uae has become an established option for the treatment of leiomyomas. Near the splenic hilum, the artery usually divides into superior and infe. Flush arteriography via the common femoral artery confirmed the presence of a pseudoaneurysm at an intrasplenic ascending branch of the splenic artery. Examined variables were demographics, mechanism of injury, abbreviated. Sangro et al used gelfoam to reduce splenic blood flow by 40 to 60%, which significantly increased both white blood cell and platelet counts. Jun 10, 2009 hypersplenism occurs in patients with chronic liver disease, and splenectomy is the definitive treatment. Complications arising from splenic embolization after blunt splenic trauma article in the american journal of surgery 1893. Patients with grade iv to v splenic injury requiring sae or sp were included in the final analysis. May 09, 2017 pancytopenia treatment by splenic artery embolisation. Sinistral portal hypertension sph is a clinical syndrome of gastric variceal hemorrhage in the setting of splenic vein thrombosis svt, mostly due to pancreatic pathology. This study assessed preoperative splenic artery embolization before laparoscopic splenectomy.
A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. How to code for a percutaneous splenic artery embolization. Advantages of single port surgery are mostly cosmetic. The indication is called preventive when the goal is to avoid secondary bleeding by decreasing blood pressure into the spleen. The methods of treatment for this condition include surgical resection, minimally invasive techniques include laparoscopic technique and endovascular therapy.
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