Tesi etd-01272023-111007 |
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Tipo di tesi
Tesi di laurea magistrale LM6
Autore
LINGUETTA, CARLO
URN
etd-01272023-111007
Titolo
Non-operative management of splenic post-traumatic injuries: a retrospective study on the performance of Splenic Artery Embolization of splenic AAST grade ≥3 lesions
Dipartimento
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
Relatori
relatore Prof.ssa Crocetti, Laura
correlatore Prof. Aquaro, Giovanni Donato
correlatore Prof. Aquaro, Giovanni Donato
Parole chiave
- AAST
- embolization
- SAE
- Spleen
Data inizio appello
14/02/2023
Consultabilità
Non consultabile
Data di rilascio
14/02/2093
Riassunto
Background
Spleen is the solid organ most frequently injured in cases of blunt abdominal trauma, particularly in young adults. It is found to be involved in over 25% of all closed abdominal traumas.
In recent years, the management of splenic injuries in stable patients has shifted from surgical approaches (operative management, OM) to non-surgical management (NOM) due to the beneficial effect of preserving the spleen's role in the immune system. Despite this shift in management, there is still a lack of standardization in protocols for the management of post-traumatic splenic injuries.
The aim of this retrospective study was to assess the success of splenic artery embolization of posttraumatic splenic injuries according to the 2018 updated AAST criteria, and to evaluate the rate of SAE complications in a cohort of patients who underwent trauma and then were submitted embolization.
Materials and Methods
The study included 24 patients who were admitted to the Emergency Department of Azienda Ospedaliero Universitaria Pisana, between February 2020 and July 2022 because of trauma and then proceeded to embolization. According to the severity of the event, complications are graded according to the CIRSE (Cardiovascular and Interventional Radiological Society of Europe) classification system.
Results
SAE was performed at a median of 7.2 hours from trauma (range 0-4 days). The median AAST grade at admission was III (range III-V). Site of embolization was proximal in 19 cases (79%) and distal in 4 cases (16.7%). One case of combined proximal and distal embolization was described.
Technical success was achieved in all patients. Major complications complications were observed in 3 patients (12.5%) and included a grade 1 infarction (n=1, 4.17%), a grade 3 abscess (n=1, 4.17%) and a grade 3 re-bleed (n=1, 4.17%). The latter two patients were submitted to splenectomy.
Technical success was achieved in 24 patients (100% patients). Clinical success was achieved in 22 patients (91.67%) with 2 patients requiring splenectomy after SAE (8.3%) at a median time of 4,5 days (range 4–5 days).
Conclusions
SAE is a safe and effective treatment in hemodynamically stable patients with intermediate-high grade posttraumatic splenic injuries. Our results show a low rate of complication and splenic salvage in 91.7% of patients.
Spleen is the solid organ most frequently injured in cases of blunt abdominal trauma, particularly in young adults. It is found to be involved in over 25% of all closed abdominal traumas.
In recent years, the management of splenic injuries in stable patients has shifted from surgical approaches (operative management, OM) to non-surgical management (NOM) due to the beneficial effect of preserving the spleen's role in the immune system. Despite this shift in management, there is still a lack of standardization in protocols for the management of post-traumatic splenic injuries.
The aim of this retrospective study was to assess the success of splenic artery embolization of posttraumatic splenic injuries according to the 2018 updated AAST criteria, and to evaluate the rate of SAE complications in a cohort of patients who underwent trauma and then were submitted embolization.
Materials and Methods
The study included 24 patients who were admitted to the Emergency Department of Azienda Ospedaliero Universitaria Pisana, between February 2020 and July 2022 because of trauma and then proceeded to embolization. According to the severity of the event, complications are graded according to the CIRSE (Cardiovascular and Interventional Radiological Society of Europe) classification system.
Results
SAE was performed at a median of 7.2 hours from trauma (range 0-4 days). The median AAST grade at admission was III (range III-V). Site of embolization was proximal in 19 cases (79%) and distal in 4 cases (16.7%). One case of combined proximal and distal embolization was described.
Technical success was achieved in all patients. Major complications complications were observed in 3 patients (12.5%) and included a grade 1 infarction (n=1, 4.17%), a grade 3 abscess (n=1, 4.17%) and a grade 3 re-bleed (n=1, 4.17%). The latter two patients were submitted to splenectomy.
Technical success was achieved in 24 patients (100% patients). Clinical success was achieved in 22 patients (91.67%) with 2 patients requiring splenectomy after SAE (8.3%) at a median time of 4,5 days (range 4–5 days).
Conclusions
SAE is a safe and effective treatment in hemodynamically stable patients with intermediate-high grade posttraumatic splenic injuries. Our results show a low rate of complication and splenic salvage in 91.7% of patients.
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