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