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Il Giornale Italiano di Radiologia Medica 2018 Marzo-Aprile;5(2):196-201

DOI: 10.23736/S2283-8376.18.00023-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

Proximal splenic artery embolization in polytraumatized patient: the volumetry to quantify the saved parenchyma

Matteo ARNÒ, Arianna NIVOLLI , Antonio BARILE, Alessandro SERAFINI, Diego IVALDI, Paolo GAZZO

Ospedale Santa Corona, Pietra Ligure, Savona, Italia


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BACKGROUND: Proximal splenic artery embolization (SAE) has become the standard of care for traumatic splenic injury in hemodynamically stable patients. Purpose of this retrospective study is to evaluate the outcome and complications of proximal embolization in spleen trauma and to suggest perfusion spleen volumetry as a vital parenchyma index.
METHODS: Between January 2009 and August 2016, 34 patients aged 16-84 years were treated with proximal or combined proximal and distal splenic embolization after blunt injuries. Lesions assessed between the II and IV degree of AAST classification were treated in hemodynamically stable or borderline polytrauma patients. Embolization was performed by occlusion of the splenic artery after the Magna pancreatic artery source with spirals, Amplatzer Plug or POD. Patients were subjected to strict clinical and instrumental monitoring (CEUS/CT with contrast agent immediately after procedure and at 48-72 hours). Data were collected. We proceeded to calculate and compare total volume and perfuse volume on CT images before and after embolization.
RESULTS: Technical success was 100% with an intra and peri-procedural mortality rate equal to 0%. Fever associated with abdominal pain were the only minor complication observed in two cases (5.89%), treated with pharmacological therapy. No rebleeding, surgery or major complications were recorded. Total non-perfused splenic volume after embolization was 3.05%, 16.9% related to proximal and distal embolization technique and only 1.1% to proximal embolization.
CONCLUSIONS: The results of our study demonstrate that this procedure is safety and has to be the first option in the II to IV degree of AAST classification of splenic injury. Proximal splenic artery embolization does not cause a significant loss of parenchyma. The perfusion spleen volumetry seems to be an appropriate method to quantify the vital parenchyma.


KEY WORDS: Therapeutic embolization - Spleen - Wounds and injuries - Interventional radiology

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