MountSinaiIR
Splenic Trauma
Indications Is Any Spleen Too Far Gone
Aaron M Fischman MD
Division of Interventional Radiology
Icahn School of Medicine at Mount Sinai
New York NY
Aaron Fischman MD
bull ConsultantAdvisory Board Terumo Interventional Systems Embolx Inc Neuwave
Medical
bull Research Grants Merit Medical
MountSinaiIR
Background
39000 adults with blunt splenic injury year in US
Most commonly injured organ in blunt abdominal
trauma
Only 10 go to urgent splenectomy
Splenic embo first described by Scalfani in 1981
MountSinaiIR
Who cares about the spleen
Infection risk is real -
Around 1 lifetime risk
Hospital costs and morbidity
associated with splenectomy
Pancreatic issues
MountSinaiIR
AAST Splenic Injury Grading System
Grade 3-5 without bleeding ndash
Proximal embo decreases risk
of splenectomy by 16-18
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 71 Number 4 October 2011
MountSinaiIR
Nonoperative Management (NOM)
Observation vs Embolization
Hemodynamics is KEY
Unstable ndash Surgery
Stable ndash CT
(predicting intervention
- 100 88 sensspec)
MountSinaiIR
Blunt Splenic Trauma - Indicators for Intervention
Active contrast extravasation
Pseudoaneurysm AV fistula
Splenic vascular injury
AAST III grade or higher
Significant blood in peritoneal
cavity
Polytrauma
Agegt50
MountSinaiIR
Curative vs Preventive Embolization
Curative
Distal ndash close to bleeding source
Gelfoam particles coils glue onyx
Preventive
Proximal ndash bw dorsal pancreatic
and pancreatic magna
Vascular plugs large coils (035)
gelfoam
MountSinaiIR
Splenic Arterial Anatomy
Near the splenic hilum ndash
superior and inferior terminal branches
each terminal branch dividing into four-to-six intrasplenic segmental branches
pancreatic branches including the dorsal pancreatic artery and greater pancreatic artery (arteria pancreatica magna)
supply neck body and tail of the pancreas
short gastric arteries
arising before splenic artery enters the splenic hilum
run in gastrosplenic ligament to supply fundus and upper part of greater curvature of the stomach and anastomose with LGA over the fundus
supplies cardia and fundal regions of the stomach
left gastroepiploic artery
runs in greater omentum along greater curvature of stomach to anastomose with right gastroepiploic artery
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
Aaron Fischman MD
bull ConsultantAdvisory Board Terumo Interventional Systems Embolx Inc Neuwave
Medical
bull Research Grants Merit Medical
MountSinaiIR
Background
39000 adults with blunt splenic injury year in US
Most commonly injured organ in blunt abdominal
trauma
Only 10 go to urgent splenectomy
Splenic embo first described by Scalfani in 1981
MountSinaiIR
Who cares about the spleen
Infection risk is real -
Around 1 lifetime risk
Hospital costs and morbidity
associated with splenectomy
Pancreatic issues
MountSinaiIR
AAST Splenic Injury Grading System
Grade 3-5 without bleeding ndash
Proximal embo decreases risk
of splenectomy by 16-18
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 71 Number 4 October 2011
MountSinaiIR
Nonoperative Management (NOM)
Observation vs Embolization
Hemodynamics is KEY
Unstable ndash Surgery
Stable ndash CT
(predicting intervention
- 100 88 sensspec)
MountSinaiIR
Blunt Splenic Trauma - Indicators for Intervention
Active contrast extravasation
Pseudoaneurysm AV fistula
Splenic vascular injury
AAST III grade or higher
Significant blood in peritoneal
cavity
Polytrauma
Agegt50
MountSinaiIR
Curative vs Preventive Embolization
Curative
Distal ndash close to bleeding source
Gelfoam particles coils glue onyx
Preventive
Proximal ndash bw dorsal pancreatic
and pancreatic magna
Vascular plugs large coils (035)
gelfoam
MountSinaiIR
Splenic Arterial Anatomy
Near the splenic hilum ndash
superior and inferior terminal branches
each terminal branch dividing into four-to-six intrasplenic segmental branches
pancreatic branches including the dorsal pancreatic artery and greater pancreatic artery (arteria pancreatica magna)
supply neck body and tail of the pancreas
short gastric arteries
arising before splenic artery enters the splenic hilum
run in gastrosplenic ligament to supply fundus and upper part of greater curvature of the stomach and anastomose with LGA over the fundus
supplies cardia and fundal regions of the stomach
left gastroepiploic artery
runs in greater omentum along greater curvature of stomach to anastomose with right gastroepiploic artery
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Background
39000 adults with blunt splenic injury year in US
Most commonly injured organ in blunt abdominal
trauma
Only 10 go to urgent splenectomy
Splenic embo first described by Scalfani in 1981
MountSinaiIR
Who cares about the spleen
Infection risk is real -
Around 1 lifetime risk
Hospital costs and morbidity
associated with splenectomy
Pancreatic issues
MountSinaiIR
AAST Splenic Injury Grading System
Grade 3-5 without bleeding ndash
Proximal embo decreases risk
of splenectomy by 16-18
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 71 Number 4 October 2011
MountSinaiIR
Nonoperative Management (NOM)
Observation vs Embolization
Hemodynamics is KEY
Unstable ndash Surgery
Stable ndash CT
(predicting intervention
- 100 88 sensspec)
MountSinaiIR
Blunt Splenic Trauma - Indicators for Intervention
Active contrast extravasation
Pseudoaneurysm AV fistula
Splenic vascular injury
AAST III grade or higher
Significant blood in peritoneal
cavity
Polytrauma
Agegt50
MountSinaiIR
Curative vs Preventive Embolization
Curative
Distal ndash close to bleeding source
Gelfoam particles coils glue onyx
Preventive
Proximal ndash bw dorsal pancreatic
and pancreatic magna
Vascular plugs large coils (035)
gelfoam
MountSinaiIR
Splenic Arterial Anatomy
Near the splenic hilum ndash
superior and inferior terminal branches
each terminal branch dividing into four-to-six intrasplenic segmental branches
pancreatic branches including the dorsal pancreatic artery and greater pancreatic artery (arteria pancreatica magna)
supply neck body and tail of the pancreas
short gastric arteries
arising before splenic artery enters the splenic hilum
run in gastrosplenic ligament to supply fundus and upper part of greater curvature of the stomach and anastomose with LGA over the fundus
supplies cardia and fundal regions of the stomach
left gastroepiploic artery
runs in greater omentum along greater curvature of stomach to anastomose with right gastroepiploic artery
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Who cares about the spleen
Infection risk is real -
Around 1 lifetime risk
Hospital costs and morbidity
associated with splenectomy
Pancreatic issues
MountSinaiIR
AAST Splenic Injury Grading System
Grade 3-5 without bleeding ndash
Proximal embo decreases risk
of splenectomy by 16-18
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 71 Number 4 October 2011
MountSinaiIR
Nonoperative Management (NOM)
Observation vs Embolization
Hemodynamics is KEY
Unstable ndash Surgery
Stable ndash CT
(predicting intervention
- 100 88 sensspec)
MountSinaiIR
Blunt Splenic Trauma - Indicators for Intervention
Active contrast extravasation
Pseudoaneurysm AV fistula
Splenic vascular injury
AAST III grade or higher
Significant blood in peritoneal
cavity
Polytrauma
Agegt50
MountSinaiIR
Curative vs Preventive Embolization
Curative
Distal ndash close to bleeding source
Gelfoam particles coils glue onyx
Preventive
Proximal ndash bw dorsal pancreatic
and pancreatic magna
Vascular plugs large coils (035)
gelfoam
MountSinaiIR
Splenic Arterial Anatomy
Near the splenic hilum ndash
superior and inferior terminal branches
each terminal branch dividing into four-to-six intrasplenic segmental branches
pancreatic branches including the dorsal pancreatic artery and greater pancreatic artery (arteria pancreatica magna)
supply neck body and tail of the pancreas
short gastric arteries
arising before splenic artery enters the splenic hilum
run in gastrosplenic ligament to supply fundus and upper part of greater curvature of the stomach and anastomose with LGA over the fundus
supplies cardia and fundal regions of the stomach
left gastroepiploic artery
runs in greater omentum along greater curvature of stomach to anastomose with right gastroepiploic artery
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
AAST Splenic Injury Grading System
Grade 3-5 without bleeding ndash
Proximal embo decreases risk
of splenectomy by 16-18
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 71 Number 4 October 2011
MountSinaiIR
Nonoperative Management (NOM)
Observation vs Embolization
Hemodynamics is KEY
Unstable ndash Surgery
Stable ndash CT
(predicting intervention
- 100 88 sensspec)
MountSinaiIR
Blunt Splenic Trauma - Indicators for Intervention
Active contrast extravasation
Pseudoaneurysm AV fistula
Splenic vascular injury
AAST III grade or higher
Significant blood in peritoneal
cavity
Polytrauma
Agegt50
MountSinaiIR
Curative vs Preventive Embolization
Curative
Distal ndash close to bleeding source
Gelfoam particles coils glue onyx
Preventive
Proximal ndash bw dorsal pancreatic
and pancreatic magna
Vascular plugs large coils (035)
gelfoam
MountSinaiIR
Splenic Arterial Anatomy
Near the splenic hilum ndash
superior and inferior terminal branches
each terminal branch dividing into four-to-six intrasplenic segmental branches
pancreatic branches including the dorsal pancreatic artery and greater pancreatic artery (arteria pancreatica magna)
supply neck body and tail of the pancreas
short gastric arteries
arising before splenic artery enters the splenic hilum
run in gastrosplenic ligament to supply fundus and upper part of greater curvature of the stomach and anastomose with LGA over the fundus
supplies cardia and fundal regions of the stomach
left gastroepiploic artery
runs in greater omentum along greater curvature of stomach to anastomose with right gastroepiploic artery
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Nonoperative Management (NOM)
Observation vs Embolization
Hemodynamics is KEY
Unstable ndash Surgery
Stable ndash CT
(predicting intervention
- 100 88 sensspec)
MountSinaiIR
Blunt Splenic Trauma - Indicators for Intervention
Active contrast extravasation
Pseudoaneurysm AV fistula
Splenic vascular injury
AAST III grade or higher
Significant blood in peritoneal
cavity
Polytrauma
Agegt50
MountSinaiIR
Curative vs Preventive Embolization
Curative
Distal ndash close to bleeding source
Gelfoam particles coils glue onyx
Preventive
Proximal ndash bw dorsal pancreatic
and pancreatic magna
Vascular plugs large coils (035)
gelfoam
MountSinaiIR
Splenic Arterial Anatomy
Near the splenic hilum ndash
superior and inferior terminal branches
each terminal branch dividing into four-to-six intrasplenic segmental branches
pancreatic branches including the dorsal pancreatic artery and greater pancreatic artery (arteria pancreatica magna)
supply neck body and tail of the pancreas
short gastric arteries
arising before splenic artery enters the splenic hilum
run in gastrosplenic ligament to supply fundus and upper part of greater curvature of the stomach and anastomose with LGA over the fundus
supplies cardia and fundal regions of the stomach
left gastroepiploic artery
runs in greater omentum along greater curvature of stomach to anastomose with right gastroepiploic artery
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Blunt Splenic Trauma - Indicators for Intervention
Active contrast extravasation
Pseudoaneurysm AV fistula
Splenic vascular injury
AAST III grade or higher
Significant blood in peritoneal
cavity
Polytrauma
Agegt50
MountSinaiIR
Curative vs Preventive Embolization
Curative
Distal ndash close to bleeding source
Gelfoam particles coils glue onyx
Preventive
Proximal ndash bw dorsal pancreatic
and pancreatic magna
Vascular plugs large coils (035)
gelfoam
MountSinaiIR
Splenic Arterial Anatomy
Near the splenic hilum ndash
superior and inferior terminal branches
each terminal branch dividing into four-to-six intrasplenic segmental branches
pancreatic branches including the dorsal pancreatic artery and greater pancreatic artery (arteria pancreatica magna)
supply neck body and tail of the pancreas
short gastric arteries
arising before splenic artery enters the splenic hilum
run in gastrosplenic ligament to supply fundus and upper part of greater curvature of the stomach and anastomose with LGA over the fundus
supplies cardia and fundal regions of the stomach
left gastroepiploic artery
runs in greater omentum along greater curvature of stomach to anastomose with right gastroepiploic artery
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Curative vs Preventive Embolization
Curative
Distal ndash close to bleeding source
Gelfoam particles coils glue onyx
Preventive
Proximal ndash bw dorsal pancreatic
and pancreatic magna
Vascular plugs large coils (035)
gelfoam
MountSinaiIR
Splenic Arterial Anatomy
Near the splenic hilum ndash
superior and inferior terminal branches
each terminal branch dividing into four-to-six intrasplenic segmental branches
pancreatic branches including the dorsal pancreatic artery and greater pancreatic artery (arteria pancreatica magna)
supply neck body and tail of the pancreas
short gastric arteries
arising before splenic artery enters the splenic hilum
run in gastrosplenic ligament to supply fundus and upper part of greater curvature of the stomach and anastomose with LGA over the fundus
supplies cardia and fundal regions of the stomach
left gastroepiploic artery
runs in greater omentum along greater curvature of stomach to anastomose with right gastroepiploic artery
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Splenic Arterial Anatomy
Near the splenic hilum ndash
superior and inferior terminal branches
each terminal branch dividing into four-to-six intrasplenic segmental branches
pancreatic branches including the dorsal pancreatic artery and greater pancreatic artery (arteria pancreatica magna)
supply neck body and tail of the pancreas
short gastric arteries
arising before splenic artery enters the splenic hilum
run in gastrosplenic ligament to supply fundus and upper part of greater curvature of the stomach and anastomose with LGA over the fundus
supplies cardia and fundal regions of the stomach
left gastroepiploic artery
runs in greater omentum along greater curvature of stomach to anastomose with right gastroepiploic artery
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Splenic Artery Anatomy
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Important Collateral Pathway to the Spleen
Dorsal pancreatic rarr
transverse pancreatic rarr
arteria pancreatica magna rarr
splenic artery
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Splenic Arterial Anatomy
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Proximal vs Distal
Proximal
Decrease perfusion pressure
(around 40mmHg)
Distal to dorsal pancreatic
Distal
Preserve as much spleen as
possible
No difference in major complications
Infection major infarction or
rebleeding
More minor infarctions with
distal
The Journal of TRAUMA Injury Infection and Critical Care bull
Volume 70 Number 1 January 2011
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Proximal Distal
Proximal is good enough
Shorter procedure
Technically less challenging
Other medical
needspolytrauma
Young patientsflouro time
What if they rebleed
Technology allows us to be
selective
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Distal Embolization ndash Initial Angio
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Distal Embolization ndash Post n-BCA
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Proximal Embolization ndash Initial Angio
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Plug Deployment ndash 5F Sarah Radial Catheter (038)
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Proximal Embolization
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Ideal Location for Proximal Embolization
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Proximal Embolization ndash Amplatzer I (guide)
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Complications
Persistent Hemorrhage
requiring splenectomy
Splenic Infarct
Delayed Splenic Rupture
InfectionAbscess
Non-target embolizationcoil migration
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Migration of Coil Mass
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Efficacy and Outcomes
1-2 lifetime risk of sepsis after
splenectomy
90 success rate of SA
embolization
Decreased mortality and hospital
stay
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Non-traumatic Splenic Embolization Indications
Hypersplenism
ITP Thalassemia
idiopathic cancer
therapy
Portal Hypertension
Improve liver fx
decrease variceal
bleed encephalopathy
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN
MountSinaiIR
Summary
Proximal embolization is probably a
good strategy in majority of patients
If active extrav psuedoaneursym AV
fistula is seen distal embolization may
be appropriate
Keep in mind patient factors
PRESERVE THE SPLEEN