From: Review of proximal splenic artery embolization in blunt abdominal trauma
Title, Author Year | Number of Patients | Study Design | Key Point(s), Data, Summary | Level of Evidence |
---|---|---|---|---|
Splenic trauma: WSES classification and guidelines for adult and pediatric patients (Coccolini et al. 2017). | NA | Review | Surgical management guidelines for splenic trauma including AAST classification and recommendations for the use of non-operative treatments. Recommendations include: Consideration of angiography and/or embolization in stable patients with AAST grade I-III splenic injury. Angiography and embolization for stable AAST grade IV-V splenic injuries. | IV |
Trauma center variation in splenic artery embolization and spleen salvage: a multicenter analysis (Banerjee et al. 2013). | 1275 | Multicenter Meta-analysis | Centers with high use of splenic artery embolization have higher spleen salvage rates and fewer nonoperative management failures. | I |
Nonoperative management of adult blunt splenic injury with and without splenic artery embolotherapy: a meta-analysis (Requarth et al. 2011). | 10,157 | Meta-analysis | Summarizes outcomes for patients with splenic injuries with non operative management. They found a higher failure rates in patients managed with observation alone compared with splenic artery embolization. Splenic artery embolization patients also showed significantly higher splenic salvage rates in grade 4 and 5 splenic injuries. | I |
Transcatheter arterial embolization of splenic artery aneurysms and pseudoaneurysms: short- and long-term results (Loffroy et al. 2008) | 17 | Retrospective | Compared outcomes of endovascular treatment of splenic artery aneurysms and pseudoaneurysms. They found no major complications, and concluded embolization of splenic artery aneurysms and pseudoaneurysms is a safe and effective method of splenic preservation. | II |
The anatomy of the fundic branches of the stomach: preliminary results (Gregorczyk et al. 2008). | NA | Descriptive laboratory study | Provides an anatomic description of the arterial vascularisation of the gastric fundus in 15 human specimens. | V |
Outcomes of Proximal Versus Distal Splenic Artery Embolization After Trauma: A Systematic Review and Meta-Analysis (Schnuriger et al. 2011). | 479 | Meta-Analysis | Analyzes 15 studies regarding the use of both proximal and distal embolization in patients with splenic trauma. Summary of outcomes and complications for proximal vs distal splenic embolization. | I |
Evaluation of the Amplatzer vascular plug for proximal splenic artery embolization (Widlus et al. 2008). | 14 | Retrospective | In these preliminary studies, Amplatzer vascular plugs were used successfully for proximal splenic artery embolization without any major complications. | II |
Delayed presentation of splenic artery pseudoaneurysms following blunt abdominal trauma (Nance and Nance 1995). | 2 | Case report | Two patients with delayed presentation of splenic artery pseudoaneurysm following blunt abdominal trauma. Both vascular injuries were diagnosed on a follow up CT scan, highlighting the need for follow up imaging in patients with blunt abdominal trauma. | V |
The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis (Rong et al. 2017). | 876 | Meta-Analysis | Comparison of PSAE vs distal embolization, and PSAE vs PSAE + distal embolization. Reports rates of success and severe complication. Lowest complications with PSAE, highest with combined proximal and distal embolization. | I |
Conservation of the spleen with distal pancreatectomy (Warshaw 1988) | NA | Clinical examples, expert opinion | Authors describe their experience with preservation splenic vascular collateral pathways via the short gastric and gastroepiploic vessels during a distal pancreatectomy. | V |
Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique (Jean-Philippe et al. 2013). | 140 | Retrospective | Discusses collateral arterial pathways for splenic circulation, which are essential to splenic preservation following proximal splenic artery embolization. | II |
Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up (Bessoud et al. 2007). | 37 | Retrospective | Proximal splenic artery embolization for the treatment of splenic injury in blunt abdominal trauma is safe and preserves long term splenic function. | II |
Splenic embolization revisited: a multicenter review (Haan et al. 2004). | 140 | Retrospective | Rebleeding following splenic embolization can occur in up to 24% of patients, but this is often treated successfully with re-embolization. Distal embolization often causes small splenic infarcts. | II |
Non-operative management of blunt splenic injury: a 5-year experience (Haan et al. 2005). | 109 | Retrospective | Single center study showing hemodynamically stable patients with grade III – V splenic lacerations treated with PSAE have a higher likelihood of splenic salvage compared with those treated with observation alone. | II |