17 year-old girl in MVC Grade 3 splenic laceration

17 year-old girl in MVC Grade 3 splenic laceration

17 year-old girl in MVC
Grade 3 splenic laceration
Fluoroscopy
Celiac Arteriogram
Proximal Splenic Embolization
Pancrea7ca Magna artery Dorsal Pancrea7c artery Plane crash
Distal Splenic artery emboliza7on Proximal versus Distal emboliza7on: outcomes and complica7ons (n=479 emboliza7ons) Failure rates: 10% overall (range 0-­‐33%). Trend toward more failures with distal emboliza7on (NS) Complica7ons Infarcts Minor (%) Major (%) Proximal 0.0 -­‐ 8.4 0.0 -­‐ 0.5 Distal 4.3 -­‐ 19.8 1.6 -­‐ 3.8 Rebleed rates all <4.5% (NS) NS Overall success rates 90% Schnüriger B, Inaba K, Konstan7nidis A, Lustenberger T, Chan LS, Demetriades D. The Journal of Trauma: Injury, Infec7on, and Cri7cal Care. 2011 Jan;70(1):252–60. Dorsal Pancrea7c Pancrea7ca Magna Embolized proximal Splenic Dorsal Pancrea7c Transverse Pancrea7c Patent distal Splenic 35 year old female on/off ATV
35 year old female on/off ATV
35 year old female on/off ATV
35 year old female on/off ATV
Hemodynamic effect of SAE
•  Splenic artery transient balloon occlusion in 7 trauma pa7ents •  Mean aor7c SBP 89 ± 22 mm Hg •  Occluded splenic MAP 47.1 ± 26 mm Hg •  Average splenic MAP drop 42 ± 19 mm Hg (48 % ± 19 %) •  Average systolic pressure drop 75.4 ± 24 mm Hg Requarth JA. J Trauma. 2010;69:1423–1426. 22 year old
kick to left abdomen
Delayed Phase 37 year old man:
Go Kart vs Car
Venous Phase Arterial Phase Complications of SAE
•  Major complica7ons 13.6% (12 of 88 pa7ents) –  Infarc7on 2.3% –  Abscess 6.8% –  Contrast nephropathy 2.3% –  Symptoma7c splenic cyst 2.3% Major complica7ons: 9 of 12 had distal emboliza7on •  Minor complica7ons 34.1% –  Pleural effusion 17% –  Coil migra7on 14.8% –  Fever 9.1% Ekeh AP, Khalaf S, Ilyas S, Kauffman S, Walusimbi M, McCarthy MC. Am J Surg. 2013;205:250–4. Summary
•  Splenic artery emboliza7on is a useful adjunct to NOM •  Staging of splenic injury: look for more than just the AAST grade •  Candidates for SAE: High grade or vascular injury •  Proximal SAE minimizes complica7ons Thank You
gej@uw.edu