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Transcatheter Embolization for Delayed Hemorrhage Caused by Blunt Splenic Trauma

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Abstract

Although the exact benefit of adjunctive splenic artery embolization (SAE) in the nonoperative management (NOM) of patients with blunt splenic trauma has been debated, the role of transcatheter embolization in delayed splenic hemorrhage is rarely addressed. The purpose of this study was to evaluate the effectiveness of SAE in the management of patients who presented at least 3 days after initial splenic trauma with delayed hemorrhage. During a 24-month period 4 patients (all male; ages 19–49 years) presented with acute onset of pain 5–70 days after blunt trauma to the left upper quadrant. Two had known splenic injuries that had been managed nonoperatively. All had computed axial tomography evidence of active splenic hemorrhage or false aneurysm on representation. All underwent successful SAE. Follow-up ranged from 28 to 370 days. These cases and a review of the literature indicate that SAE is safe and effective for NOM failure caused by delayed manifestations of splenic arterial injury.

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References

  1. Peitzman AB, Heil B, Rivera L et al (2000) Blunt splenic injury in adults: Multi–institutional study of the Eastern Association for the Surgery of Trauma. J Trauma 49:177–879

    Article  CAS  PubMed  Google Scholar 

  2. Hurtuk M, Reed RL II, Esposito TJ et al (2006) Trauma surgeons practice what they preach: the NTDB story on solid organ injury management. J Trauma 61:243–545

    Article  PubMed  Google Scholar 

  3. Schwalke MA, Crowley JP, Spencer P et al (1991) Splenic artery ligation for splenic salvage: clinical experience and immune function. J Trauma 31:385–388

    Article  CAS  PubMed  Google Scholar 

  4. Gaarder C, Dormagen JB, Eken T et al (2006) Nonoperative management of splenic injuries: improved results with angioembolization. J Trauma 61:192–198

    Article  PubMed  Google Scholar 

  5. Wahl WL, Ahrns KS, Chen S et al (2004) Blunt splenic injury: operation versus angiographic embolization. Surgery 136:891–899

    Article  PubMed  Google Scholar 

  6. Savage SA, Zarzaur BL, Magnotti LJ et al (2008) The evolution of blunt splenic injury: resolution and progression. J Trauma 64:1085–1092

    Article  PubMed  Google Scholar 

  7. Dent D, Alsabrook G, Erickson BA et al (2004) Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization. J Trauma 56:1063–1067

    Article  PubMed  Google Scholar 

  8. McIntyre LK, Schiff M, Jurkovich GJ (2005) Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg 140:563–589

    Article  PubMed  Google Scholar 

  9. Peitzman AB, Harbrecht BG, Rivera L et al (2005) Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg 201:179–187

    Article  PubMed  Google Scholar 

  10. Smith J, Armen S, Cook CH et al (2008) Blunt splenic injuries: have we watched long enough? J Trauma 64:656–665

    Article  PubMed  Google Scholar 

  11. Davis KA, Fabian TC, Croce MA et al (1998) Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms. J Trauma 44:1008–1015

    Article  CAS  PubMed  Google Scholar 

  12. Weinberg JA, Magnotti LJ, Croce MA et al (2007) The utility of serial computed tomography imaging of blunt splenic injury: still worth a second look? J Trauma 62:1143–1148

    Article  PubMed  Google Scholar 

  13. Gamblin TC, Wall CE Jr, Royer GM et al (2005) Delayed splenic rupture: case reports and review of the literature. J Trauma 59:1231–1234

    Article  PubMed  Google Scholar 

  14. Sclafani SJ, Shaftan GW, Scalea TM et al (1995) Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma 39:818–827

    Article  CAS  PubMed  Google Scholar 

  15. Rajani RR, Claridge JA, Yowler CJ et al (2006) Improved outcome of adult blunt splenic injury: a cohort analysis. Surgery 140:625–632

    Article  PubMed  Google Scholar 

  16. Haan JM, Bochicchio GV, Kramer N et al (2005) Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma 58:492–498

    Article  PubMed  Google Scholar 

  17. Bee TK, Croce MA, Miller PR et al (2001) Failures of splenic nonoperative management: is the glass half empty or half full? J Trauma 50:230–236

    Article  CAS  PubMed  Google Scholar 

  18. Wei B, Hemmila MR, Arbabi S et al (2008) Angioembolization reduces operative intervention for blunt splenic injury. J Trauma 64:1472–1477

    Article  PubMed  Google Scholar 

  19. Harbrecht BG, Ko SH, Watson GA et al (2007) Angiography for blunt splenic trauma does not improve the success rate of nonoperative management. J Trauma 63:44–49

    Article  PubMed  Google Scholar 

  20. Cocanour CS, Moore FA, Ware DN et al (1998) Delayed complications of nonoperative management of blunt adult splenic trauma. Arch Surg 133:619–624

    Article  CAS  PubMed  Google Scholar 

  21. Velmahos GC, Chan LS, Kamel E et al (2000) Nonoperative management of splenic injuries: have we gone too far? Arch Surg 135:674–681

    Article  CAS  PubMed  Google Scholar 

  22. Haan JM, Biffl W, Knudson MM et al (2004) Splenic embolization revisited: a multicenter review. J Trauma 56:542–547

    Article  PubMed  Google Scholar 

  23. Crawford RS, Tabbara M, Sheridan R et al (2007) Early discharge after nonoperative management for splenic injuries: increased patient risk caused by late failure? Surgery 142:337–342

    Article  PubMed  Google Scholar 

  24. Hagiwara A, Murata A, Matsuda T et al (2004) The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation. J Trauma 57:271–277

    Article  PubMed  Google Scholar 

  25. Hagiwara A, Fukushima H, Murata A et al (2005) Blunt splenic injury: usefulness of transcatheter arterial embolization in patients with a transient response to fluid resuscitation. Radiology 235:57–64

    Article  PubMed  Google Scholar 

  26. Velmahos GC, Toutouzas KG, Vassiliu P et al (2002) A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma 53:303–308

    Article  PubMed  Google Scholar 

  27. Lin WC, Chen YF, Lin CH et al (2008) Emergent transcatheter arterial embolization in hemodynamically unstable patients with blunt splenic injury. Acad Radiol 15:201–208

    Article  PubMed  Google Scholar 

  28. Haan JM, Marmery H, Shanmuganathan K et al (2007) Experience with splenic main coil embolization and significance of new or persistent pseudoaneurym: reembolize, operate, or observe. J Trauma 63:615–619

    Article  PubMed  Google Scholar 

  29. Smith HE, Biffl WL, Majercik SD et al (2006) Splenic artery embolization: have we gone too far? J Trauma 61:541–546

    Article  PubMed  Google Scholar 

  30. Biffl WL, Ray CE Jr, Moore EE et al (2002) Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg 235:699–707

    Article  PubMed  Google Scholar 

  31. Hoffer EK, Sclafani SJ, Herskowitz MM et al (1997) Natural history of arterial injuries diagnosed with arteriography. J Vasc Interv Radiol 8(1 Pt 1):43–53

    Article  CAS  PubMed  Google Scholar 

  32. Dormagen JB, Gaarder C, Sandvik L et al (2008) Intraparenchymal Doppler ultrasound after proximal embolization of the splenic artery in trauma patients. Eur Radiol 18:1224–1231

    Article  PubMed  Google Scholar 

  33. Cooney R, Ku J, Cherry R et al (2005) Limitations of splenic angioembolization in treating blunt splenic injury. J Trauma 59:926–932

    Article  PubMed  Google Scholar 

  34. Hagiwara A, Yukioka T, Ohta S et al (1996) Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization. AJR Am J Roentgenol 167:159–166

    CAS  PubMed  Google Scholar 

  35. Wu SC, Chow KC, Lee KH et al (2007) Early selective angioembolization improves success of nonoperative management of blunt splenic injury. Am Surg 73:897–902

    PubMed  Google Scholar 

  36. Konstantakos AK, Barnoski AL, Plaisier BR et al (1999) Optimizing the management of blunt splenic injury in adults and children. Surgery 126:805–813

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Vascular and Interventional Radiology, Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA

    Steven J. Krohmer & Eric K. Hoffer

  2. Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, 03756, USA

    Kenneth W. Burchard

Authors
  1. Steven J. Krohmer
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  2. Eric K. Hoffer
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  3. Kenneth W. Burchard
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Correspondence to Eric K. Hoffer.

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Krohmer, S.J., Hoffer, E.K. & Burchard, K.W. Transcatheter Embolization for Delayed Hemorrhage Caused by Blunt Splenic Trauma. Cardiovasc Intervent Radiol 33, 861–865 (2010). https://doi.org/10.1007/s00270-009-9535-5

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  • DOI: https://doi.org/10.1007/s00270-009-9535-5

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