ARTERIAL EMBOLIZATION

SPLENIC ARTERY EMBOLIZATION

Introduction

Last updated: apr 11, 2023

The spleen has many important roles including T-cell proliferation and antibody production and phagocytosis of senescent red blood cells. Therefore, in the setting of splenic trauma, splenectomy is avoided when possible.

SAE may also be indicated in a non-traumatic setting like portal hypertension, hypeersplhnism or splint artery aneurysm

Splenic vascularization

  • AsTP Arteries of the Tail of the Pancreas
  • CHA Common Hepatic Artery
  • CPA Caudal Pancreatic Artery
  • GPA Great Pancreatic Artery
  • IPB Inferior Polar Branch
  • LGA Left Gastric Artery
  • LGOA Left Gastro‑omental Artery
  • LLA Lower Lobar Artery
  • PGA Posterior Gastric Artery
  • RGOA Right Gastro‑omental Artery
  • SGAs Short Gastric Arteries
  • SPAs Short Pancreatic Arteries
  • SPB Superior polar Branch
  • SPA Splenic Artery
  • TPA Transverse Pancreatic Artery
  • ULA Upper Lobar Artery

 

Anatomy

File NameTypePermissionsChanged DateDateSize

AAST Spleen
 

Indications

Trauma

  • AAST grade II or higher

Non-trauma
  • Hypersplenism
    • improve the platelet count (idiopathic thrombocytopenic purpura, thalassemia, idiopathic hypersplenism, cytopenia induced by anticancer chemotherapy)
  • Portal hypertension
    • decrease variceal hemorrhage,
    • treat hepatic encephalopathy
    • improve blood counts

 

Contra indications

Absolute

  • Technical like coeliac trunk occlusion

Relative

 

Workup

  • Only in case of non-traumatic embolisation

 

Pre procedural

  • Correct any coagulopathy before embolization, (achieving hemostasis depends on ability to clot).
  • 1g Cefazolin
  • CTA

 

Materials

Essentials

  • Sheath 6-9F
  • Cobra catheter
  • Microcatheter
  • Pushable 0.035" and 0.018" coils
  • Detachable 0.018" coils
  • Ampler plug (10 and 12 mm AVP II)
  • 300-500 micron particles in case of non-traumatic embolisation

Non-Essentials

  • Steerable guiding catheter (Oscor)

 

Positioning the patient

  • Head first
  • Supine

Distal pancreatic artery
PSAE

The ideal location for embolisation is between the distal pancreatic artery (DPA) and the great pancreatic artery (GPA), to avoid devascularization of the pancreas and ischemic pancreatitis; as well as to preserve blood supply to the spleen

 

The procedure in steps

  • Time out
  • Positioneren patient
  • Wassen met chloorhexidine en steriel afdekken
  • Ultrasound guided femoral artery access
  • Celiac artery angiogram with a 4-5F curved catheter (Cobra C2 or Rosch Celiac RC2, Cook Medical) to evaluate not only the splenic artery anatomy but also sources of collaterals to the spleen, including the left gastric artery, gastroepiploic arteries, and pancreatic artery branches.
  • In case of a single parenchymal lesion, perform curative distal splenic artery embolization with pushable coils
  • In case of no visible or multiple parenchymal lesions perform proximal splenic artery emboliztion with plug or detachable coils
  • Sign out

 

Tips and tricks

  • Consider using a steerable guiding catheter (Oscor) for increased stability
  • Coils should be sized to be 20–30% larger than the target vessel
  • Plugs should be sized 30–50% larger than the target vessel

 

Complications

  • Persistent hemorrhage 11% (with half of these patients requiring splenectomy)
  • Splenic infarct not requiring any treatment occurred 21%
  • Splenic abscess 3%
  • Pancreatitis (w/wo pseudocyst formation)
  • Pleural effusion

The only complication discrepancy between PSAE and DSAE is splenic infarct, with ~3x higher rate of infarct in distal embolizations (1.6% - 3.8% rate of major splenic infarctions in distal embolization)

 

Post-op

PSAE

  • Good flow to the spleen; no antibiotics
  • Poor flow; Amoxicillin/clavulanic acid 7d

DSAE
  • Amoxicillin/clavulanic acid 5d

 

Report

 

Literature

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