The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

Jing-Jing Rong; Dan Liu; Ming Liang; Qing-Hua Wang; Jing-Yang Sun; Quan-Yu Zhang; Cheng-Fei Peng; Feng-Qi Xuan; Li-Jun Zhao; Xiao-Xiang Tian; Ya-Ling Han

doi:10.1186/s40779-017-0125-6

Your Location：

Home >

Browse articles >

The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

RESEARCH | Updated：2026-03-12

- The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis
- The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis
- MMR 2018年5卷第1期页码：41-52
- Affiliations：
  
  1.Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
  2.Department of Cardiology, Xinqiao Hospital of Third Military Medical University, Chongqing 400038, China
- Author bio：
  
  *: hanyl@medmail.com.cn
- Funds：
  
  the Innovation Project of Military Medicine(16CXZ006)
- DOI：10.1186/s40779-017-0125-6
  中图分类号：
- 纸质出版：2018-03
- Accepted：
Scan QR Code
The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis[J]. MMR, 2018,5(1):41-52.

Rong et al.: The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis. Mil Med Res, 2017, 4: 17
The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis[J]. MMR, 2018,5(1):41-52. DOI： 10.1186/s40779-017-0125-6.

Rong et al.: The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis. Mil Med Res, 2017, 4: 17 DOI： 10.1186/s40779-017-0125-6.

摘要

Abstract

Background:

Splenic artery embolization (SAE) has been an effective adjunct to the Non-operative management (NOM) for blunt splenic injury (BSI). However

the optimal embolization techniques are still inconclusive. To further understand the roles of different embolization locations and embolic materials in SAE

we conducted this system review and meta-analyses.

Methods:

Clinical studies related to SAE for adult patients were researched in electronic databases

included PubMed

Embase

ScienceDirect and Google Scholar Search (between October 1991 and March 2013)

and relevant information was extracted. To eliminate the heterogeneity

a sensitivity analysis was conducted on two reduced study sets. Then

the pooled outcomes were compared and the quality assessments were performed using Newcastle-Ottawa Scale (NOS). The SAE success rate

incidences of life-threatening complications of different embolization techniques were compared by χ

test in 1st study set. Associations between different embolization techniques and clinical outcomes were evaluated by fixed-effects model in 2nd study set.

Results:

Twenty-three studies were included in 1st study set. And then

13 of them were excluded

because lack of the necessary details of SAE. The remaining 10 studies comprised 2nd study set

and quality assessments were performed using NOS. In 1st set

the primary success rate is 90.1% and the incidence of life-threatening complications is 20.4%

though the cases which required surgical intervention are very few (6.4%). For different embolization locations

there was no obvious association between primary success rate and embolization location in both 1st and 2nd study sets (

0.05). But in 2nd study set

it indicated that proximal embolization reduced severe complications and complications needed surgical management. As for the embolic materials

the success rate between coil and gelfoam is not significant. However

coil is associated with a lower risk of life-threatening complications

as well as less complications requiring surgical management.

Conclusion:

Different embolization techniques affect the clinical outcomes of SAE. The proximal embolization is the best option due to the less life-threatening complications. For commonly embolic material

coil is superior to gelfoam for fewer severe complications and less further surgery management.

关键词

Keywords

references

Banerjee A , Duane TM , Wilson SP , Haney S , O’Neill PJ , Evans HL , et al . Trauma center variation in splenic artery embolization and spleen salvage: A multicenter analysis . J Trauma . 2013 ; 75 : 69 - 75 .

Peitzman AB , Heil B , Rivera L , Federle MB , Harbrecht BG , Clancy KD , et al . Blunt splenic injury in adults: multi-institutional study of the Eastern Association for the Surgery of Trauma . J Trauma . 2000 ; 49 : 177 - 89 .

Cogbill TH , Moore EE , Jurkovich GJ , Morris JA , Mucha JRP , Shackford SR , et al . Nonoperative management of blunt splenic trauma: a multicenter experience . J Trauma . 1989 ; 29 : 1312 - 7 .

van der Vlies CH , Hoekstra J , Ponsen KJ , Reekers JA , van Delden OM , Goslings JC . Impact of splenic artery embolization on the success rate of nonoperative management for blunt splenic injury . Cardiovasc Intervent Radiol . 2012 ; 35 : 76 - 81 .

Smith J , Caldwell E , D’Amours S , Jalaludin B , Sugrue M . Abdominal trauma: a disease in evolution . ANZ J Surg . 2005 ; 75 : 790 - 4 .

Uranüs S , Pfeifer J . Nonoperative treatment of blunt splenic injury . World J Surg . 2001 ; 25 : 1405 - 7 .

Dasgupta N , Matsumoto AH , Arslan B , Turba UC , Sabri S , Angle JF . Embolization therapy for traumatic splenic lacerations . Cardiovasc Intervent Radiol . 2012 ; 35 : 795 - 806 .

Gauer JM , Gerber-Paulet S , Seiler C , Schweizer WP . Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy . World J Surg . 2008 ; 32 : 2730 - 5 .

Wiseman J , Brown CV , Weng J , Salim A , Rhee P , Demetriades D . Splenectomy for trauma increases the rate of early postoperative infections . Am Surg . 2006 ; 72 : 947 - 50 .

Liu PP , Lee WC , Cheng YF , Hsieh PM , Hsieh YM , Tan BL , et al . Use of splenic artery embolization as an adjunct to nonsurgical management of blunt splenic injury . J Trauma . 2004 ; 56 : 768 - 73 .

Ekeh AP , Khalaf S , Ilyas S , Kauffman S , Walusimbi M , McCarthy MC . Complications arising from splenic artery embolization: a review of an 11-year experience . Am J Surg . 2013 ; 205 : 250 - 4 .

Pirasteh A , Snyder LL , Lin R , Rosenblum D , Reed S , Sattar A , et al . Temporal assessment of splenic function in patients who have undergone percutaneous image-guided splenic artery embolization in the setting of trauma . J Vasc Interv Radiol . 2012 ; 23 : 80 - 2 .

Schnüriger B , Inaba K , Konstantinidis A , Lustenberger T , Chan LS , Demetriades D . Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis . J Trauma . 2011 ; 70 : 252 - 60 .

Requarth JA , D’Agostino Jr RB , Miller PR . Nonoperative management of adult blunt splenic injury with and without splenic artery embolotherapy: a metaanalysis . J Trauma . 2011 ; 71 : 898 - 903 .

Imbrogno BF , Ray CE . Splenic Artery Embolization in Blunt Trauma . Semin Interv Radiol . 2012 ; 29 ( 2 ): 147 - 9 .

Liu PP , Liu HT , Hsieh TM , Huang CY , Ko SF . Nonsurgical management of delayed splenic rupture after blunt trauma . J Trauma . 2012 ; 72 : 1019 - 23 .

Malhotra AK , Carter RF , Lebman DA , Carter DS , Riaz OJ , Aboutanos MB , et al . Preservation of splenic immunocompetence after splenic artery angioembolization for blunt splenic injury . J Trauma . 2010 ; 69 : 1126 - 30 .

Jeremitsky E , Kao A , Carlton C , Rodriguez A , Ong A . Does splenic embolization and grade of splenic injury impact nonoperative management in patients sustaining blunt splenic trauma? Am Surg . 2011 ; 77 : 215 - 20 .

Chen IC , Wang SC , Shih HC , Wang CY , Liu CC , Wen YS , et al . Spleen artery embolization increases the success of nonoperative management following blunt splenic injury . J Chin Med Assoc . 2011 ; 74 : 341 - 4 .

Walusimbi MS , Dominguez KM , Sands JM , Markert RJ , McCarthy MC . Circulating cellular and humoral elements of immune function following splenic arterial embolisation or splenectomy in trauma patients . Injury . 2012 ; 43 : 180 - 3 .

Skattum J , Titze TL , Dormagen JB , Aaberge IS , Bechensteen AG , Gaarder PL , et al . Preserved splenic function after angioembolisation of high grade injury . Injury . 2012 ; 43 : 62 - 6 .

Shih HC , Wang CY , Wen YS , Wu JK , Huang MS , Huang CI , et al . Spleen artery embolization aggravates endotoxin hyporesponse of peripheral blood mononuclear cells in patients with spleen injury . J Trauma . 2010 ; 68 : 532 - 7 .

Requarth JA , Miller PR . The splenic artery stump pressure is affected by arterial anatomy after proximal embolotherapy in blunt splenic injury . J Trauma Acute Care Surg . 2012 ; 73 : 1221 - 4 .

Abada HT , Golzarian J . Gelatine sponge particles: handling characteristics for endovascular use . Tech Vasc Interv Radiol . 2007 ; 10 : 257 - 60 .

Franco F , Monaco D , Volpi A , Marcato C , Larini P , Rossi C . The role of arterial embolization in blunt splenic injury . Radiol Med . 2011 ; 116 : 454 - 65 .

Wu SC , Fu CY , Chen RJ , Chen YF , Wang YC , Chung PK , et al . Higher incidence of major complications after splenic embolization for blunt splenic injuries in elderly patients . Am J Emerg Med . 2011 ; 29 : 135 - 40 .

Smith HE , Biffl WL , Majercik SD , Jednacz J , Lambiase R , Cioffi WG . Splenic artery embolization: have we gone too far? J Trauma . 2006 ; 61 : 541 - 6 .

Haan JM , Biffl W , Knudson MM , Davis KA , Oka T , Majercik S , et al . Splenic embolization revisited: a multicenter review . J Trauma . 2004 ; 56 : 542 - 7 .

Moog R , Mefat L , Kauffmann I , Becmeur F . Non-operative management of splenic trauma . Arch Pediatr . 2005 ; 12 : 219 - 23 .

Ekeh AP , McCarthy MC , Woods RJ , Haley E . Complications arising from splenic embolization after blunt splenic trauma . Am J Surg . 2005 ; 189 : 335 - 9 .

Ekeh AP , Izu B , Ryan M , McCarthy MC . The impact of splenic artery embolization on the management of splenic trauma: an 8-year review . Am J Surg . 2009 ; 197 : 337 - 41 .

Wu SC , Chen RJ , Yang AD , Tung CC , Lee KH . Complications associated with embolization in the treatment of blunt splenic injury . World J Surg . 2008 ; 32 : 476 - 82 .

Liu D , Guo H , Li Y , Xu X , Yang K , Bai Y . Association between polymorphisms in the promoter regions of matrix metalloproteinases (MMPs) and risk of cancer metastasis: a meta-analysis . PLoS One . 2012 ; 7 : e31251 .

Mantel N , Haenszel W . Statistical aspects of the analysis of data from retrospective studies of disease . J Natl Cancer Inst . 1959 ; 22 : 719 - 48 .

DerSimonian R , Laird N . Meta-analysis in clinical trials . Control Clin Trials . 1986 ; 7 : 177 - 88 .

Egger M , Davey Smith G , Schneider M , Minder C . Bias in meta-analysis detected by a simple, graphical test . BMJ . 1997 ; 315 : 629 - 34 .

Bhullar IS , Frykberg ER , Siragusa D , Chesire D , Paul J , Tepas 3rd JJ , et al . Age does not affect outcomes of nonoperative management of blunt splenic trauma . J Am Coll Surg . 2012 ; 214 : 958 - 64 .

Requarth JA . Distal splenic artery hemodynamic changes during transient proximal splenic artery occlusion in blunt splenic injury patients: a mechanism of delayed splenic hemorrhage . J Trauma . 2010 ; 69 : 1423 - 6 .

Krohmer SJ , Hoffer EK , Burchard KW . Transcatheter embolization for delayed hemorrhage caused by blunt splenic trauma . Cardiovasc Intervent Radiol . 2010 ; 33 : 861 - 5 .

Sclafani SJ . The role of angiographic hemostasis in salvage of the injured spleen . Radiology . 1981 ; 141 : 645 - 50 .

Paul DB , Opalek JM . Proximal splenic arterial embolization may also result in pancreatic necrosis . J Trauma . 2011 ; 71 : 268 - 9 .

Harbrecht BG , Ko SH , Watson GA , Forsythe RM , Rosengart MR , Peitzman AB . Angiography for blunt splenic trauma does not improve the success rate of nonoperative management . J Trauma . 2007 ; 63 : 44 - 9 .

Rajani RR , Claridge JA , Yowler CJ , Patrick P , Wiant A , Summers JI , et al . Improved outcome of adult blunt splenic injury: a cohort analysis . Surgery . 2006 ; 140 : 625 - 32 .

Bessoud B , Denys A , Calmes JM , Madoff D , Qanadli S , Schnyder P , et al . Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization? AJR Am J Roentgenol . 2006 ; 186 : 779 - 85 .

Bessoud B , Denys A . Main splenic artery embolization using coils in blunt splenic injuries: effects on the intrasplenic blood pressure . Eur Radiol . 2004 ; 14 : 1718 - 9 .

Elliott JA , Millward SF , Kribs SW . Use of computed tomographic scanning and embolization to improve the nonoperative management of splenic trauma: critically appraised topic . Can Assoc Radiol J . 2003 ; 54 : 183 - 4 .

Ng EH , Comin J , David E , Pugash R , Annamalai G . AMPLATZER Vascular Plug 4 for proximal splenic artery embolization in blunt trauma . J Vasc Intrev Radiol . 2012 ; 23 : 976 - 9 .

Sabe AA , Claridge JA , Rosenblum DI , Lie K , Malangoni MA . The effects of splenic artery embolization on nonoperative management of blunt splenic injury: a 16-year experience . J Trauma . 2009 ; 67 : 565 - 72 .

Kaseje N , Agarwal S , Burch M , Glantz A , Emhoff T , Burke P , et al . Short-term outcomes of splenectomy avoidance in trauma patients . Am J Surg . 2008 ; 196 : 213 - 7 .

Haan JM , Marmery H , Shanmuganathan K , Mirvis SE , Scalea TM . Experience with splenic main coil embolization and significance of new or persistent pseudoaneurysm: reembolize, operate, or observe . J Trauma . 2007 ; 63 : 615 - 9 .

Wu SC , Chow KC , Lee KH , Tung CC , Yang AD , Lo CJ . Early selective angioembolization improves success of nonoperative management of blunt splenic injury . Am Surg . 2007 ; 73 : 897 - 902 .

Bessoud B , Duchosal MA , Siegrist CA , Schlegel S , Doenz F , Calmes JM , et al . Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up . J Trauma . 2007 ; 62 : 1481 - 6 .

Killeen KL , Shanmuganathan K , Boyd-Kranis R , Scalea TM , Mirvis SE . CT findings after embolization for blunt splenic trauma . J Vasc Intrev Radiol . 2001 ; 12 : 209 - 14 .

Sclafani SJ , Shaftan GW , Scalea TM , Patterson LA , Kohl L , Kantor A , et al . Nonoperative salvage of computed tomography–diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis . J Trauma . 1995 ; 39 : 818 - 27 .

Sclafani SJ , Weisberg A , Scalea TM , Phillips TF , Duncan AO . Blunt splenic injuries: nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of the splenic artery . Radiology . 1991 ; 181 : 189 - 96 .

Gaarder C , Dormagen JB , Eken T , Skaga NO , Klow NE , Pillgram-Larsen J , et al . Nonoperative management of splenic injuries: improved results with angioembolization . J Trauma . 2006 ; 61 : 192 - 8 .

Cooney R , Ku J , Cherry R , Maish 3rd GO , Carney D , Scorza LB , et al . Limitations of splenic angioembolization in treating blunt splenic injury . J Trauma . 2005 ; 59 : 926 - 32 .

Hagiwara A , Fukushima H , Murata A , Matsuda H , Shimazaki S . Blunt splenic injury: usefulness of transcatheter arterial embolization in patients with a transient response to fluid resuscitation . Radiology . 2005 ; 235 : 57 - 64 .

Wei B , Hemmila MR , Arbabi S , Taheri PA , Wahl WL . Angioembolization reduces operative intervention for blunt splenic injury . J Trauma . 2008 ; 64 : 1472 - 7 .

Haan J , Scott J , Boyd-Kranis RL , Ho S , Kramer M , Scalea TM . Admission angiography for blunt splenic injury: advantages and pitfalls . J Trauma . 2001 ; 51 : 1161 - 5 .

Dent D , Alsabrook G , Erickson BA , Myers J , Wholey M , Stewart R , et al . Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization . J Trauma . 2004 ; 56 : 1063 - 7 .

Stassen NA , Bhullar I , Cheng JD , Crandall ML , Friese RS , Guillamondegui OD , et al . Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline . J Trauma Acute Care Surg . 2012 ; 73 : S294 - 300 .

Harbrecht BG , Peitzman AB , Rivera L , Heil B , Croce M , Morris JA , et al . Contribution of age and gender to outcome of blunt splenic injury in adults: multicenter study of the eastern association for the surgery of trauma . J Trauma . 2001 ; 51 : 887 - 95 .

Albrecht RM , Schermer CR , Morris A . Nonoperative management of blunt splenic injuries: factors influencing success in age > 55 years . Am Surg . 2002 ; 68 : 227 - 30 .

Knudson MM , Maull KI . Nonoperative management of solid organ injuries: past, present, and future . Surg Clin N Am . 1999 ; 79 : 1357 - 71 .

Gaunt WT , McCarthy MC , Lambert CS , Anderson GL . Traditional criteria for observation of splenic trauma should be challenged . Am Surg . 1999 ; 65 : 689 - 91 .

Siriratsivawong K , Zenati M , Watson GA , Harbrecht BG . Nonoperative management of blunt splenic trauma in the elderly: does age play a role? Am Surg . 2007 ; 73 : 585 - 9 .

Davis KA , Fabian TC , Croce MA , Gavant ML , Flick PA , Minard G , et al . Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms . J Trauma . 1998 ; 44 : 1008 - 13 .

Jander HP , Russinovich NA . Transcatheter gelfoam embolization in abdominal, retroperitoneal, and pelvic hemorrhage . Radiology . 1980 ; 136 : 337 - 44 .

Omert LA , Salyer D , Dunham CM , Porter J , Silva A , Protetch J . Implications of the “contrast blush” finding on computed tomographic scan of the spleen in trauma . J Trauma . 2001 ; 51 : 272 - 8 .

浏览量

Downloads

CSCD

文章被引用时，请邮件提醒。

Submit

工具集

关联资源

Endovascular embolization of cerebral arteriovenous malformation with N-butyl-2 cyanoacrylate

Angiographic embolization for refractory epistaxis

Diagnosis of carotid body tumor by digital subtraction angiography