Blunt abdominal trauma Splenic and renal embolization

Jan Engström 20140519

Trauma 2013

Antal traumaemboliseringar/år Hybridsal (Brattström)

1182

1065

898

331

440

605

3 1 6 0

200

400

600

800

1000

1200

1400

2011 2012 2013

Trauma 1 el 2

Trauma 3

Okänt

Type of trauma %

Jan Engström 20140519

21,6

8,4

6,2

4,2

1,2

1,5

7,9

9,4

14,1

23,2

0,1

1,9

0,4

0 5 10 15 20 25

Trafik: motorfordonsolycka

Trafik: motorcykelolycka

Trafik: cyklist

Trafik: fotgängare

Trafik: annat

Skjuten

Hugg, ex kniv

Slagen med eller träffad av trubbigt föremål

Lågt fall, samma plan

Högt fall, från högre plan

Explosionsskada, "blast injury"

Annan skademekanism

Okänt Unknown

Other

Blast injury

High level fall

Low level fall

Hit by blunt object

Stab wound

GSW

Traffic :Other

Pedestrian

Bicykle

Mc

Car

Linus Blohmé - Trauma - Strålskydd

Angio/Endovascular

Surgery

Anestesia

New Technics

ECMO etc

1%

Splenic trauma

5 Name and Date of the Lecture

• The spleen is affected in 32% of patients with traumatic

abdominal injuries

Smith et al ANZ J Surg 75:790-794

• Non Operative Management (NOM) has become standard

of care for hemodynamically stable patients.

• Two ways: Observation, SAE

Jan Engström 20140519

Complication frequency in NOM

-observation

Grade 1 4,8%

Grade 2 9,5%

Grade 3 19,6%

Grade 4 33,3%

Grade 5 75%

J Trauma 2000;49:177-187

Complication frequency in NOM

SAE

• The splenic salvage rate after observation increased from 79%

to 100% after implementation of SAE.

8 Name and Date of the Lecture

Cardiovasc Intervent radiol (2012).

Indications for Splenic Artery Embolization:

CT findings:

Contrast extravasation

pseudoaneurysm

AV-fistula

Large hemiperitoneum

High grade of injury (3-5)

Cardiovasc Intervent radiol (2012).

Two ways to SAE

Proximal coiling of main splenic artery:

Quicker and sometimes easier

What to do if bleeding does not stop?

Selectiv coiling of focal bleeding branches.

Demands microcatheter

Uncertainity of complete embolization

Larger infarctions(?)

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Jan Engström 20140519

Amplatzer vascular plug

8 mm plug in 0,38 catheter (AVP4)

Oversize 30-50%

Larger plugs in 6F sheets

Platinum coils

Oversize 25%

Stop in time

Diagram of typical celiac axis anatomy.

A, aorta; AIPD, anterior inferior

pancreaticoduodenal artery; ASPD,

anterior superior pancreaticoduodenal

artery; C, celiac axis; CP, caudal

pancreatic artery; DP, dorsal pancreatic

artery; GD, gastroduodenal artery; H,

common hepatic artery; LG, left gastric

artery; PIPD, posterior inferior

pancreaticoduodenal artery; PM,

pancreata magna; RGE, right

gastroepiploic artery; S, splenic artery;

SM, superior mesenteric artery; TP,

transverse pancreatic artery.

The use of SAE

Over 80% of grade 4-5 were successfully treated by NOM

Splenic salvage rate 87% over all

No difference in outcome between proximal or distal embolization

Haan et al J Trauma 2004;56 542-7

Blunt renal trauma

• One and a half is better than one…

• Selective coil embolization most common

• If need for total closure – AVP or coils in main artery

• Talk with the anesthesiologist

• When in doubt- leave the sheet

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High speed single mc-accident

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21 Name and Date of the Lecture

22 Name and Date of the Lecture

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18 yo man falling from a fence

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Bicycle acciden

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29 Name and Date of the Lecture

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Summary

• SAE is a safe proceedure and reduces splenectomies

• Proximal or distal embolization does not seem to matter

concerning outcome

• Splenic function after SAE seems to be intact.

• In renal trauma embolization one can often save parts of

damaged kidney. Complete embolization is often not needed.

Jan Engström 20140519