title: Proximal Splenic Artery Embolization In Blunt Splenic Trauma.
abstract: BACKGROUND
  Proximal embolization of the splenic artery (PSAE) has recently been reported for traumatic splenic injury. The suggested mechanism of action entails a decrease in the splenic blood pressure without ischemia due to collateral blood supply. The main complications of selective embolization are continuous bleeding, splenic infarcts and splenic abscesses. The main complications of observation alone are continuous bleeding and formation of splenic pseudoaneurysms. Our aim was to assess the efficacy of PSAE in the cessation of bleeding without formation of pseudoaneurysms, and the outcome of the spleen after such intervention.
  
  
  METHODS
  A prospective observational study of all patients undergoing PSAE for traumatic splenic injury in our institution over a 33-month period. Clinical and Doppler sonographic examinations were performed to assess cessation of bleeding, splenic blood flow, and formation of splenic pseudoaneurysms, infarcts or abscesses.
  
  
  RESULTS
  During 33 months, 11 patients with blunt abdominal trauma and tomographic evidence of either high grade or actively bleeding splenic injuries were treated by PSAE. During follow-up, no patient underwent surgery or repeated embolization. Preserved blood flow was found on Doppler sonography in 82% of the patients and no pseudoaneurysms were demonstrated. A perisplenic collection was found in one patient and responded well to percutaneous drainage.
  
  
  CONCLUSIONS
  Proximal embolization of the splenic artery for severe splenic injury is highly successful in cessation of bleeding while preserving splenic architecture. There were minimal complications in this series demonstrated by clinical and Doppler examinations.
authors.affiliation: General Surgery Division of Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel.
authors.forename: Osnat
authors.initials: O
authors.lastname: Zmora
authors.affiliation: Unit of Angiography, Division of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel.
authors.forename: Yitzhak
authors.initials: Y
authors.lastname: Kori
authors.affiliation: Unit of Angiography, Division of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Samuels
authors.affiliation: Unit of Ultrasonography, Division of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel.
authors.forename: Ada
authors.initials: A
authors.lastname: Kessler
authors.affiliation: Division of Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel.
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.affiliation: Divisions of Burns, Trauma and Critical Care, University of Miami Faculty of Medicine, Miami, Florida, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Klausner
authors.affiliation: The Yitzhak Rabin Trauma Center, Division of Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Tel-Aviv, Israel. sofferdror@hotmail.com.|The Yitzhak Rabin Trauma Center, Division of Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, 6 Weizman St, 64239, Tel-Aviv, Israel. sofferdror@hotmail.com.
authors.forename: Dror
authors.initials: D
authors.lastname: Soffer
keywords: Embolization; Injury; Proximal; Spleen
references.citation: Int Surg. 2001 Oct-Dec;86(4):201-5
references.pmid: 12056461
references.citation: Am Surg. 1990 Dec;56(12):774-7
references.pmid: 2268105
references.citation: Surg Endosc. 1987;1(4):229-31
references.pmid: 3455039
references.citation: J Trauma. 2007 Jun;62(6):1481-6
references.pmid: 17563670
references.citation: J Trauma. 2006 May;60(5):1083-6
references.pmid: 16688074
references.citation: J Trauma. 1995 Mar;38(3):323-4
references.pmid: 7897707
references.citation: J Trauma. 1999 Oct;47(4):651-8
references.pmid: 10528598
references.citation: AJR Am J Roentgenol. 1984 May;142(5):957-9
references.pmid: 6609580
references.citation: Am Surg. 1997 Aug;63(8):694-9
references.pmid: 9247436
references.citation: Am J Surg. 2005 Mar;189(3):335-9
references.pmid: 15792763
references.citation: J Trauma. 2001 Nov;51(5):887-95
references.pmid: 11706335
references.citation: Ann Surg. 1998 May;227(5):708-17; discussion 717-9
references.pmid: 9605662
references.citation: J Vasc Interv Radiol. 2001 Feb;12 (2):209-14
references.pmid: 11265885
references.citation: J Trauma. 1995 Nov;39(5):818-25; discussion 826-7
references.pmid: 7473996
references.citation: An Esp Pediatr. 1989 May;30(5):385-6
references.pmid: 2757304
references.citation: J Comput Assist Tomogr. 2002 Jan-Feb;26(1):107-12
references.pmid: 11801912
references.citation: Am Surg. 2003 Mar;69(3):238-42; discussion 242-3
references.pmid: 12678481
references.citation: J Trauma. 2001 May;50(5):835-42
references.pmid: 11371838
references.citation: Eur Radiol. 2004 Sep;14 (9):1718-9
references.pmid: 14963688
references.citation: J Trauma. 2006 Sep;61(3):541-4; discussion 545-6
references.pmid: 16966984
references.citation: Radiology. 1977 Oct;125(1):95-102
references.pmid: 897195
references.citation: Arch Surg. 2000 Jun;135(6):674-9; discussion 679-81
references.pmid: 10843363
references.citation: Injury. 1991 Sep;22(5):349-52
references.pmid: 1806491
references.citation: Clin Nucl Med. 1998 Jun;23 (6):394-5
references.pmid: 9619336
references.citation: AJR Am J Roentgenol. 2006 Mar;186(3):779-85
references.pmid: 16498106