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La radiologia medica

, Volume 116, Issue 3, pp 454–465 | Cite as

The role of arterial embolization in blunt splenic injury

  • D. Monaco
  • F. FrancoEmail author
  • C. Marcato
  • P. Larini
  • C. Rossi
  • A. Volpi
Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica

Abstract

Purpose

The aim of study was to evaluate the results of our experience with transarterial embolization based on a modified algorithm in patients with splenic injury.

Materials and methods

We collected data of patients admitted to our hospital from January 2006 to August 2008 for blunt splenic injury. During this period, 46 patients were admitted for splenic trauma, of whom 17 were treated surgically, 15 conservatively and 14 with percutaneous embolisation (13 men, mean age 44.8, mean injury severity score 18.5, six with grade IV and eight with contrast blush). Patients in shock were referred for laparotomy and splenectomy, whereas those who were haemodynamically stable or responsive to fluid resuscitation were further evaluated with computed tomography (CT). In the presence of imaging evidence of splenic injury ranging from grade I to grade III (n=15) a conservative approach was adopted, whereas haemodynamically unstable patients with grade V injury (n=17) were treated with splenectomy. Embolisation was performed in 14 patients with grade IV injury or in the event of contrast extravasation, regardless of injury grade. In patients with diffuse organ damage, we embolised the main splenic artery, whereas in the case of localised injury, embolisation was selective.

Results

Proximal embolization was required in eight cases and distal coil embolization in six. In 13 cases, we placed magnetic-resonance-compatible coils 4–6 mm in diameter; only one patient was treated with gel-foam injection. Immediate technical success was achieved in all cases. In 13/14 patients (92.9%), no periprocedural complications were observed, whereas the remaining patient underwent splenectomy within 24 h due to recurrent bleeding.

Conclusions

On the basis of our algorithm, it is possible to reach a quick decision on the most appropriate treatment for patients presenting with blunt abdominal trauma, and splenic artery embolization seems to offer a reliable option in those with high-grade splenic injury or active bleeding.

Keywords

Blunt splenic injury Splenic artery embolization Nonoperative management Spleen Splenic salvage 

Il ruolo dell’embolizzazione percuranea nel trauma splenico sanguinante

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare i risultati della nostra esperienza sull’embolizzazione percutanea in pazienti con trauma splenico, sulla base di un algoritmo modificato.

Materiali e metodi

Abbiamo raccolto i dati dei pazienti con trauma della milza ammessi nel nostro centro da gennaio 2006 ad agosto 2008. In questo periodo sono stati ammessi 46 pazienti con lesione splenica posttraumatica, di cui 17 sono stati trattati chirurgicamente, 15 con trattamento conservativo e 14 con embolizzazione percutanea (13 maschi, età media 44,8, injury severity score [ISS] 18,5 circa, 6 con grado IV e 8 con stravaso di mezzo di contrasto). I pazienti in stato di shock sono stati immediatamente sottoposti a laparotomia e splenectomia, mentre quelli emodinamicamente stabili o responsivi alla somministrazione di fluidi sono stati valutati con TC. In base al dato strumentale, in 15 pazienti, con lesioni spleniche di grado I, II e III è stato considerato il trattamento conservativo, mentre 17 pazienti emodinamicamente instabili, con lesioni di V grado, sono stati sottoposti a splenectomia. L’embolizzazione è stata eseguita in 14 pazienti con lesioni spleniche di IV grado o in caso di stravaso di mezzo di contrasto indipendentemente dal grado della lesione. L’embolizzazione dell’arteria splenica principale è stata effettuata nei pazienti con danno d’organo diffuso, mentre in caso di lesioni localizzate, è stata eseguita l’occlusione selettiva del solo segmento splenico interessato.

Risultati

L’embolizzazione prossimale si è resa necessaria in 8 pazienti e quella distale in 6. In 13 casi sono state posizionate spirali RM compatibili con diametro variabile tra 4 e 6 mm; in un solo paziente sono state iniettate solo particelle riassorbibili. Il successo tecnico immediato è stato ottenuto in tutti i casi. In 13/14 casi (92,9%) non sono state osservate complicanze post-procedurali, mentre in un solo paziente, trattato con particelle riassorbibili, si è resa necessaria la splenectomia per recidiva di sanguinamento a 24 ore dall’embolizzazione.

Conclusioni

Sulla base del nostro algoritmo, è possibile una veloce decisione sul trattamento più opportuno delle lesioni spleniche post-traumatiche e l’embolizzazione percutanea sembra offrire un’affidabile opzione in pazienti con lesioni d’organo di grado elevato o con sanguinamento attivo.

Parole chiave

Trauma splenico Embolizzazione dell’arteria splenica Management conservativo Milza Salvataggio di milza 

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Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • D. Monaco
    • 1
  • F. Franco
    • 2
    Email author
  • C. Marcato
    • 2
  • P. Larini
    • 2
  • C. Rossi
    • 2
  • A. Volpi
    • 3
  1. 1.Radiologia, Azienda Ospedaliera “SS. Annunziata”TarantoItaly
  2. 2.Radiologia e Diagnostica per Immagini, Sez. di Radiologia Interventistica e VascolareAzienda Ospedaliera Universitaria di ParmaParmaItaly
  3. 3.1° Serv. Anestesia e RianimazioneAzienda Ospedaliero Universitaria di ParmaParmaItaly

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