Amplatzer vascular plug 4 for proximal splenic artery embolization in trauma: A preliminary experience

Abstract text (incl. references and figure legends)

Introduction: splenic artery embolization(SAE) is nowadays widely used for hemodynamically stable patients with splenic trauma as part of non-operative management. The purpose of the study is to evaluate the efficacy of Amplatzer vascular plug(AVP) in the emergency setting.

Material and method: in the last 2 years 14 SAE were performed at Cattinara University hospital for blunt splenic trauma. Three patients underwent proximal SAE with AVP4. Data were retrospectively collected and analyzed. An angioCT scan was performed 48-72 hours after SAE to verify the procedure"s success. The follow-up was carried out with abdominal ultrasound until complete spleen healing.

Results: all patients were admitted for motor-vehicle-accident. At admission patients were hemodynamically stable. The CT scan revealed in both cases a grade IV splenic injury(AAST classification). After CT scan, patients immediately underwent SAE with AVP4. Mean time to occlusion was 33 minutes. Angio-CT scan performed after 48-72 hours confirmed the correct placement of AVP and no complications were registered after the procedure. During follow up no splenic infarction, migration of plug or rebleeding was recorded.

Conclusions: The possibility to obtain a precise and rapid deployment, combined with the low risk of migration as compared to coils, are very useful in emergency setting. Our preliminary experience confirmed the efficacy, usefulness and safety of AVP. Furthermore, during the follow-up persistent occlusion of the artery was observed.

References:

Edmund H et al. AMPLATZER Vascular Plug 4 for Proximal Splenic Artery Embolization in Blunt Trauma. J Vasc Interv Radiol 2012;23:976–979 Jambon E, et al. Proximal embolization of splenic artery in acute trauma: Comparison between Penumbra occlusion device versus coils or Amplatzer vascular plug. Diagn Interv Imaging(2018), Coccolini et al. Splenic trauma:WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg(2017)

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