Splenic artery embolization changes the management of blunt splenic injury: an observational analysis of 680 patients graded by the revised 2018 AAST-OIS
Background This study aimed to evaluate the management of blunt splenic injury (BSI) and highlight the role of splenic artery embolization (SAE). Methods We conducted a retrospective review of all patients with BSI over 15 years. Splenic injuries were graded by the 2018 revision of the American Asso...
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| Veröffentlicht in: | Surgical endoscopy 2023-01, Vol.37 (1), p.371-381 |
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| description | Background
This study aimed to evaluate the management of blunt splenic injury (BSI) and highlight the role of splenic artery embolization (SAE).
Methods
We conducted a retrospective review of all patients with BSI over 15 years. Splenic injuries were graded by the 2018 revision of the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS). Our hospital provide 24/7 in-house surgeries and 24/7 in-house interventional radiology facility. Patients with BSI who arrived hypotensive and were refractory to resuscitation required surgery and patients with vascular injury on abdominal computed tomography were considered for SAE.
Results
In total, 680 patients with BSI, the number of patients who underwent nonoperative management with observation (NOM-obs), SAE, and surgery was 294, 234, and 152, respectively. The number of SAEs increased from 4 (8.3%) in 2001 to 23 (60.5%) in 2015 (
p
|
| doi_str_mv | 10.1007/s00464-022-09531-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9839812</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2702180353</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-b2486039d1e624094e8c3521f5378b0b6253bcebb4d7188d3b380f0cfb3255953</originalsourceid><addsrcrecordid>eNp9kctu1DAUhi0EokPhBVggS2zYBI4vSWwWSKOqhUqVupiytuzEmfHIiQc7GSm8CW-L50K5LFj5cr7_9_H5EXpN4D0BqD8kAF7xAigtQJaMFPAELQhntKCUiKdoAZJBQWvJL9CLlLaQeUnK5-iClbKilMoF-rHaeTu4Bus42jhj25vg3Xc9ujDgZqOHtU143Fjc60GvbW-HEYcOGz_lTTpr3bCd4vwR6wEHk2zcH-Xa5wvt5-TSQVIJwLtcyA4Jr6NubYvNfPSOdu9SPlIgAi-Xq4fi_nb1Ej3rtE_21Xm9RF9vrh-uvhR3959vr5Z3RcNrPhaGclEBky2xFeUguRUNKynpSlYLA6aiJTONNYa3NRGiZYYJ6KDpDKNlmcd2iT6dfHeT6W3b5P6i9moXXa_jrIJ26u_K4DZqHfZKCiYFodng3dkghm-TTaPqXWqs93qwYUqK1pDjAFayjL79B92GKeYhHagqd12zqs4UPVFNDClF2z02Q0Adklen5FVOXh2TV5BFb_78xqPkV9QZYCcg5VKONf5--z-2PwGMqLoE</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2765217367</pqid></control><display><type>article</type><title>Splenic artery embolization changes the management of blunt splenic injury: an observational analysis of 680 patients graded by the revised 2018 AAST-OIS</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Lin, Being-Chuan ; Wu, Cheng-Hsien ; Wong, Yon-Cheong ; Chen, Huan-Wu ; Fu, Chen-Ju ; Huang, Chen-Chih ; Wu, Chen-Te ; Hsieh, Chi-Hsun</creator><creatorcontrib>Lin, Being-Chuan ; Wu, Cheng-Hsien ; Wong, Yon-Cheong ; Chen, Huan-Wu ; Fu, Chen-Ju ; Huang, Chen-Chih ; Wu, Chen-Te ; Hsieh, Chi-Hsun</creatorcontrib><description>Background
This study aimed to evaluate the management of blunt splenic injury (BSI) and highlight the role of splenic artery embolization (SAE).
Methods
We conducted a retrospective review of all patients with BSI over 15 years. Splenic injuries were graded by the 2018 revision of the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS). Our hospital provide 24/7 in-house surgeries and 24/7 in-house interventional radiology facility. Patients with BSI who arrived hypotensive and were refractory to resuscitation required surgery and patients with vascular injury on abdominal computed tomography were considered for SAE.
Results
In total, 680 patients with BSI, the number of patients who underwent nonoperative management with observation (NOM-obs), SAE, and surgery was 294, 234, and 152, respectively. The number of SAEs increased from 4 (8.3%) in 2001 to 23 (60.5%) in 2015 (
p
< 0.0001); conversely, the number of surgeries decreased from 21 (43.8%) in 2001 to 4 (10.5%) in 2015 (
p
= 0.001). The spleen-related mortality rate of NOM-obs, SAEs, and surgery was 0%, 0.4%, and 7.2%, respectively. In the SAE subgroup, according to the 2018 AAST-OIS, 234 patients were classified as grade II,
n
= 3; III,
n
= 21; IV,
n
= 111; and V,
n
= 99, respectively.; and compared with 1994 AST-OIS, 150 patients received a higher grade and the total number of grade IV and V injuries ranged from 96 (41.0%) to 210 (89.7%) (
p
< 0.0001). On angiography, 202 patients who demonstrated vascular injury and 187 achieved hemostasis after SAE with a 92.6% success rate. Six of the 15 patients failed to SAE preserved the spleen after second embolization with a 95.5% salvage rate.
Conclusions
Our data confirm the superiority of the 2018 AAST-OIS and support the role of SAE in changing the trend of management of BSI.
Graphical abstract</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-022-09531-0</identifier><identifier>PMID: 35962229</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdomen ; Abdominal Surgery ; Critical care ; Embolization ; Embolization, Therapeutic ; Emergency medical care ; Endoscopy ; Fistula ; Gastroenterology ; Gynecology ; Hematoma ; Hemoglobin ; Hepatology ; Hospitals ; Humans ; Injuries ; Medical imaging ; Medicine ; Medicine & Public Health ; Mortality ; Original ; Original Article ; Proctology ; Pseudoaneurysm ; Retrospective Studies ; Spleen ; Spleen - diagnostic imaging ; Splenic Artery - diagnostic imaging ; Success ; Surgery ; Tomography ; Trauma ; Trauma centers ; Treatment Outcome ; Vascular System Injuries ; Veins & arteries ; Wounds, Nonpenetrating - diagnostic imaging ; Wounds, Nonpenetrating - therapy</subject><ispartof>Surgical endoscopy, 2023-01, Vol.37 (1), p.371-381</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-b2486039d1e624094e8c3521f5378b0b6253bcebb4d7188d3b380f0cfb3255953</citedby><cites>FETCH-LOGICAL-c474t-b2486039d1e624094e8c3521f5378b0b6253bcebb4d7188d3b380f0cfb3255953</cites><orcidid>0000-0002-5391-0900</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-022-09531-0$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-022-09531-0$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35962229$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lin, Being-Chuan</creatorcontrib><creatorcontrib>Wu, Cheng-Hsien</creatorcontrib><creatorcontrib>Wong, Yon-Cheong</creatorcontrib><creatorcontrib>Chen, Huan-Wu</creatorcontrib><creatorcontrib>Fu, Chen-Ju</creatorcontrib><creatorcontrib>Huang, Chen-Chih</creatorcontrib><creatorcontrib>Wu, Chen-Te</creatorcontrib><creatorcontrib>Hsieh, Chi-Hsun</creatorcontrib><title>Splenic artery embolization changes the management of blunt splenic injury: an observational analysis of 680 patients graded by the revised 2018 AAST-OIS</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
This study aimed to evaluate the management of blunt splenic injury (BSI) and highlight the role of splenic artery embolization (SAE).
Methods
We conducted a retrospective review of all patients with BSI over 15 years. Splenic injuries were graded by the 2018 revision of the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS). Our hospital provide 24/7 in-house surgeries and 24/7 in-house interventional radiology facility. Patients with BSI who arrived hypotensive and were refractory to resuscitation required surgery and patients with vascular injury on abdominal computed tomography were considered for SAE.
Results
In total, 680 patients with BSI, the number of patients who underwent nonoperative management with observation (NOM-obs), SAE, and surgery was 294, 234, and 152, respectively. The number of SAEs increased from 4 (8.3%) in 2001 to 23 (60.5%) in 2015 (
p
< 0.0001); conversely, the number of surgeries decreased from 21 (43.8%) in 2001 to 4 (10.5%) in 2015 (
p
= 0.001). The spleen-related mortality rate of NOM-obs, SAEs, and surgery was 0%, 0.4%, and 7.2%, respectively. In the SAE subgroup, according to the 2018 AAST-OIS, 234 patients were classified as grade II,
n
= 3; III,
n
= 21; IV,
n
= 111; and V,
n
= 99, respectively.; and compared with 1994 AST-OIS, 150 patients received a higher grade and the total number of grade IV and V injuries ranged from 96 (41.0%) to 210 (89.7%) (
p
< 0.0001). On angiography, 202 patients who demonstrated vascular injury and 187 achieved hemostasis after SAE with a 92.6% success rate. Six of the 15 patients failed to SAE preserved the spleen after second embolization with a 95.5% salvage rate.
Conclusions
Our data confirm the superiority of the 2018 AAST-OIS and support the role of SAE in changing the trend of management of BSI.
Graphical abstract</description><subject>Abdomen</subject><subject>Abdominal Surgery</subject><subject>Critical care</subject><subject>Embolization</subject><subject>Embolization, Therapeutic</subject><subject>Emergency medical care</subject><subject>Endoscopy</subject><subject>Fistula</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hematoma</subject><subject>Hemoglobin</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Injuries</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Original</subject><subject>Original Article</subject><subject>Proctology</subject><subject>Pseudoaneurysm</subject><subject>Retrospective Studies</subject><subject>Spleen</subject><subject>Spleen - diagnostic imaging</subject><subject>Splenic Artery - diagnostic imaging</subject><subject>Success</subject><subject>Surgery</subject><subject>Tomography</subject><subject>Trauma</subject><subject>Trauma centers</subject><subject>Treatment Outcome</subject><subject>Vascular System Injuries</subject><subject>Veins & arteries</subject><subject>Wounds, Nonpenetrating - diagnostic imaging</subject><subject>Wounds, Nonpenetrating - therapy</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1DAUhi0EokPhBVggS2zYBI4vSWwWSKOqhUqVupiytuzEmfHIiQc7GSm8CW-L50K5LFj5cr7_9_H5EXpN4D0BqD8kAF7xAigtQJaMFPAELQhntKCUiKdoAZJBQWvJL9CLlLaQeUnK5-iClbKilMoF-rHaeTu4Bus42jhj25vg3Xc9ujDgZqOHtU143Fjc60GvbW-HEYcOGz_lTTpr3bCd4vwR6wEHk2zcH-Xa5wvt5-TSQVIJwLtcyA4Jr6NubYvNfPSOdu9SPlIgAi-Xq4fi_nb1Ej3rtE_21Xm9RF9vrh-uvhR3959vr5Z3RcNrPhaGclEBky2xFeUguRUNKynpSlYLA6aiJTONNYa3NRGiZYYJ6KDpDKNlmcd2iT6dfHeT6W3b5P6i9moXXa_jrIJ26u_K4DZqHfZKCiYFodng3dkghm-TTaPqXWqs93qwYUqK1pDjAFayjL79B92GKeYhHagqd12zqs4UPVFNDClF2z02Q0Adklen5FVOXh2TV5BFb_78xqPkV9QZYCcg5VKONf5--z-2PwGMqLoE</recordid><startdate>20230101</startdate><enddate>20230101</enddate><creator>Lin, Being-Chuan</creator><creator>Wu, Cheng-Hsien</creator><creator>Wong, Yon-Cheong</creator><creator>Chen, Huan-Wu</creator><creator>Fu, Chen-Ju</creator><creator>Huang, Chen-Chih</creator><creator>Wu, Chen-Te</creator><creator>Hsieh, Chi-Hsun</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5391-0900</orcidid></search><sort><creationdate>20230101</creationdate><title>Splenic artery embolization changes the management of blunt splenic injury: an observational analysis of 680 patients graded by the revised 2018 AAST-OIS</title><author>Lin, Being-Chuan ; Wu, Cheng-Hsien ; Wong, Yon-Cheong ; Chen, Huan-Wu ; Fu, Chen-Ju ; Huang, Chen-Chih ; Wu, Chen-Te ; Hsieh, Chi-Hsun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-b2486039d1e624094e8c3521f5378b0b6253bcebb4d7188d3b380f0cfb3255953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdomen</topic><topic>Abdominal Surgery</topic><topic>Critical care</topic><topic>Embolization</topic><topic>Embolization, Therapeutic</topic><topic>Emergency medical care</topic><topic>Endoscopy</topic><topic>Fistula</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hematoma</topic><topic>Hemoglobin</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Injuries</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Original</topic><topic>Original Article</topic><topic>Proctology</topic><topic>Pseudoaneurysm</topic><topic>Retrospective Studies</topic><topic>Spleen</topic><topic>Spleen - diagnostic imaging</topic><topic>Splenic Artery - diagnostic imaging</topic><topic>Success</topic><topic>Surgery</topic><topic>Tomography</topic><topic>Trauma</topic><topic>Trauma centers</topic><topic>Treatment Outcome</topic><topic>Vascular System Injuries</topic><topic>Veins & arteries</topic><topic>Wounds, Nonpenetrating - diagnostic imaging</topic><topic>Wounds, Nonpenetrating - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lin, Being-Chuan</creatorcontrib><creatorcontrib>Wu, Cheng-Hsien</creatorcontrib><creatorcontrib>Wong, Yon-Cheong</creatorcontrib><creatorcontrib>Chen, Huan-Wu</creatorcontrib><creatorcontrib>Fu, Chen-Ju</creatorcontrib><creatorcontrib>Huang, Chen-Chih</creatorcontrib><creatorcontrib>Wu, Chen-Te</creatorcontrib><creatorcontrib>Hsieh, Chi-Hsun</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lin, Being-Chuan</au><au>Wu, Cheng-Hsien</au><au>Wong, Yon-Cheong</au><au>Chen, Huan-Wu</au><au>Fu, Chen-Ju</au><au>Huang, Chen-Chih</au><au>Wu, Chen-Te</au><au>Hsieh, Chi-Hsun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Splenic artery embolization changes the management of blunt splenic injury: an observational analysis of 680 patients graded by the revised 2018 AAST-OIS</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-01-01</date><risdate>2023</risdate><volume>37</volume><issue>1</issue><spage>371</spage><epage>381</epage><pages>371-381</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
This study aimed to evaluate the management of blunt splenic injury (BSI) and highlight the role of splenic artery embolization (SAE).
Methods
We conducted a retrospective review of all patients with BSI over 15 years. Splenic injuries were graded by the 2018 revision of the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS). Our hospital provide 24/7 in-house surgeries and 24/7 in-house interventional radiology facility. Patients with BSI who arrived hypotensive and were refractory to resuscitation required surgery and patients with vascular injury on abdominal computed tomography were considered for SAE.
Results
In total, 680 patients with BSI, the number of patients who underwent nonoperative management with observation (NOM-obs), SAE, and surgery was 294, 234, and 152, respectively. The number of SAEs increased from 4 (8.3%) in 2001 to 23 (60.5%) in 2015 (
p
< 0.0001); conversely, the number of surgeries decreased from 21 (43.8%) in 2001 to 4 (10.5%) in 2015 (
p
= 0.001). The spleen-related mortality rate of NOM-obs, SAEs, and surgery was 0%, 0.4%, and 7.2%, respectively. In the SAE subgroup, according to the 2018 AAST-OIS, 234 patients were classified as grade II,
n
= 3; III,
n
= 21; IV,
n
= 111; and V,
n
= 99, respectively.; and compared with 1994 AST-OIS, 150 patients received a higher grade and the total number of grade IV and V injuries ranged from 96 (41.0%) to 210 (89.7%) (
p
< 0.0001). On angiography, 202 patients who demonstrated vascular injury and 187 achieved hemostasis after SAE with a 92.6% success rate. Six of the 15 patients failed to SAE preserved the spleen after second embolization with a 95.5% salvage rate.
Conclusions
Our data confirm the superiority of the 2018 AAST-OIS and support the role of SAE in changing the trend of management of BSI.
Graphical abstract</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35962229</pmid><doi>10.1007/s00464-022-09531-0</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-5391-0900</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Surgical endoscopy, 2023-01, Vol.37 (1), p.371-381 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdomen Abdominal Surgery Critical care Embolization Embolization, Therapeutic Emergency medical care Endoscopy Fistula Gastroenterology Gynecology Hematoma Hemoglobin Hepatology Hospitals Humans Injuries Medical imaging Medicine Medicine & Public Health Mortality Original Original Article Proctology Pseudoaneurysm Retrospective Studies Spleen Spleen - diagnostic imaging Splenic Artery - diagnostic imaging Success Surgery Tomography Trauma Trauma centers Treatment Outcome Vascular System Injuries Veins & arteries Wounds, Nonpenetrating - diagnostic imaging Wounds, Nonpenetrating - therapy |
| title | Splenic artery embolization changes the management of blunt splenic injury: an observational analysis of 680 patients graded by the revised 2018 AAST-OIS |
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