Upload
others
View
5
Download
0
Embed Size (px)
Citation preview
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(?)
11 Name and Date of the Lecture
12 Name and Date of the Lecture
13 Name and Date of the Lecture
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
18 Name and Date of the Lecture
High speed single mc-accident
19 Name and Date of the Lecture
20 Name and Date of the Lecture
21 Name and Date of the Lecture
22 Name and Date of the Lecture
23 Name and Date of the Lecture
18 yo man falling from a fence
24 Name and Date of the Lecture
25 Name and Date of the Lecture
Bicycle acciden
26 Name and Date of the Lecture
27 Name and Date of the Lecture
28 Name and Date of the Lecture
29 Name and Date of the Lecture
30 Name and Date of the Lecture
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