Cargando…

Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy—An Ancillary Study

The spleen is the most commonly injured organ in blunt abdominal trauma. Its management depends on hemodynamic stability. According to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS ≥ 3), stable patients with high-grade splenic injuries may benefit from preventive pr...

Descripción completa

Detalles Bibliográficos
Autores principales: Sammoud, Skander, Ghelfi, Julien, Barbois, Sandrine, Beregi, Jean-Paul, Arvieux, Catherine, Frandon, Julien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304633/
https://www.ncbi.nlm.nih.gov/pubmed/37373879
http://dx.doi.org/10.3390/jpm13060889
_version_ 1785065555951091712
author Sammoud, Skander
Ghelfi, Julien
Barbois, Sandrine
Beregi, Jean-Paul
Arvieux, Catherine
Frandon, Julien
author_facet Sammoud, Skander
Ghelfi, Julien
Barbois, Sandrine
Beregi, Jean-Paul
Arvieux, Catherine
Frandon, Julien
author_sort Sammoud, Skander
collection PubMed
description The spleen is the most commonly injured organ in blunt abdominal trauma. Its management depends on hemodynamic stability. According to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS ≥ 3), stable patients with high-grade splenic injuries may benefit from preventive proximal splenic artery embolization (PPSAE). This ancillary study, using the SPLASH multicenter randomized prospective cohort, evaluated the feasibility, safety, and efficacy of PPSAE in patients with high-grade blunt splenic trauma without vascular anomaly on the initial CT scan. All patients included were over 18 years old, had high-grade splenic trauma (≥AAST-OIS 3 + hemoperitoneum) without vascular anomaly on the initial CT scan, received PPSAE, and had a CT scan at one month. Technical aspects, efficacy, and one-month splenic salvage were studied. Fifty-seven patients were reviewed. Technical efficacy was 94% with only four proximal embolization failures due to distal coil migration. Six patients (10.5%) underwent combined embolization (distal + proximal) due to active bleeding or focal arterial anomaly discovered during embolization. The mean procedure time was 56.5 min (SD = 38.1 min). Embolization was performed with an Amplatzer™ vascular plug in 28 patients (49.1%), a Penumbra occlusion device in 18 patients (31.6%), and microcoils in 11 patients (19.3%). There were two hematomas (3.5%) at the puncture site without clinical consequences. There were no rescue splenectomies. Two patients were re-embolized, one on Day 6 for an active leak and one on Day 30 for a secondary aneurysm. Primary clinical efficacy was, therefore, 96%. There were no splenic abscesses or pancreatic necroses. The splenic salvage rate on Day 30 was 94%, while only three patients (5.2%) had less than 50% vascularized splenic parenchyma. PPSAE is a rapid, efficient, and safe procedure that can prevent splenectomy in high-grade spleen trauma (AAST-OIS) ≥ 3 with high splenic salvage rates.
format Online
Article
Text
id pubmed-10304633
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-103046332023-06-29 Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy—An Ancillary Study Sammoud, Skander Ghelfi, Julien Barbois, Sandrine Beregi, Jean-Paul Arvieux, Catherine Frandon, Julien J Pers Med Article The spleen is the most commonly injured organ in blunt abdominal trauma. Its management depends on hemodynamic stability. According to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS ≥ 3), stable patients with high-grade splenic injuries may benefit from preventive proximal splenic artery embolization (PPSAE). This ancillary study, using the SPLASH multicenter randomized prospective cohort, evaluated the feasibility, safety, and efficacy of PPSAE in patients with high-grade blunt splenic trauma without vascular anomaly on the initial CT scan. All patients included were over 18 years old, had high-grade splenic trauma (≥AAST-OIS 3 + hemoperitoneum) without vascular anomaly on the initial CT scan, received PPSAE, and had a CT scan at one month. Technical aspects, efficacy, and one-month splenic salvage were studied. Fifty-seven patients were reviewed. Technical efficacy was 94% with only four proximal embolization failures due to distal coil migration. Six patients (10.5%) underwent combined embolization (distal + proximal) due to active bleeding or focal arterial anomaly discovered during embolization. The mean procedure time was 56.5 min (SD = 38.1 min). Embolization was performed with an Amplatzer™ vascular plug in 28 patients (49.1%), a Penumbra occlusion device in 18 patients (31.6%), and microcoils in 11 patients (19.3%). There were two hematomas (3.5%) at the puncture site without clinical consequences. There were no rescue splenectomies. Two patients were re-embolized, one on Day 6 for an active leak and one on Day 30 for a secondary aneurysm. Primary clinical efficacy was, therefore, 96%. There were no splenic abscesses or pancreatic necroses. The splenic salvage rate on Day 30 was 94%, while only three patients (5.2%) had less than 50% vascularized splenic parenchyma. PPSAE is a rapid, efficient, and safe procedure that can prevent splenectomy in high-grade spleen trauma (AAST-OIS) ≥ 3 with high splenic salvage rates. MDPI 2023-05-24 /pmc/articles/PMC10304633/ /pubmed/37373879 http://dx.doi.org/10.3390/jpm13060889 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sammoud, Skander
Ghelfi, Julien
Barbois, Sandrine
Beregi, Jean-Paul
Arvieux, Catherine
Frandon, Julien
Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy—An Ancillary Study
title Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy—An Ancillary Study
title_full Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy—An Ancillary Study
title_fullStr Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy—An Ancillary Study
title_full_unstemmed Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy—An Ancillary Study
title_short Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy—An Ancillary Study
title_sort preventive proximal splenic artery embolization for high-grade aast-ois adult spleen trauma without vascular anomaly on the initial ct scan: technical aspect, safety, and efficacy—an ancillary study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10304633/
https://www.ncbi.nlm.nih.gov/pubmed/37373879
http://dx.doi.org/10.3390/jpm13060889
work_keys_str_mv AT sammoudskander preventiveproximalsplenicarteryembolizationforhighgradeaastoisadultspleentraumawithoutvascularanomalyontheinitialctscantechnicalaspectsafetyandefficacyanancillarystudy
AT ghelfijulien preventiveproximalsplenicarteryembolizationforhighgradeaastoisadultspleentraumawithoutvascularanomalyontheinitialctscantechnicalaspectsafetyandefficacyanancillarystudy
AT barboissandrine preventiveproximalsplenicarteryembolizationforhighgradeaastoisadultspleentraumawithoutvascularanomalyontheinitialctscantechnicalaspectsafetyandefficacyanancillarystudy
AT beregijeanpaul preventiveproximalsplenicarteryembolizationforhighgradeaastoisadultspleentraumawithoutvascularanomalyontheinitialctscantechnicalaspectsafetyandefficacyanancillarystudy
AT arvieuxcatherine preventiveproximalsplenicarteryembolizationforhighgradeaastoisadultspleentraumawithoutvascularanomalyontheinitialctscantechnicalaspectsafetyandefficacyanancillarystudy
AT frandonjulien preventiveproximalsplenicarteryembolizationforhighgradeaastoisadultspleentraumawithoutvascularanomalyontheinitialctscantechnicalaspectsafetyandefficacyanancillarystudy