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Sarquis LM, Collaço IA, Toderke EL, Fontes HS, Nassif AT, Freitas ACTDE. Epidemiological profile of patients undergoing non-operative management of solid organ injury and associated factors with mortality. Rev Col Bras Cir 2024; 51:e20243734. [PMID: 38808820 DOI: 10.1590/0100-6991e-20243734-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/18/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Trauma primarily affects the economically active population, causing social and economic impact. The non-operative management of solid organ injuries aims to preserve organ function, reducing the morbidity and mortality associated with surgical interventions. The aim of study was to demonstrate the epidemiological profile of patients undergoing non-operative management in a trauma hospital and to evaluate factors associated with mortality in these patients. METHODS This is a historical cohort of patients undergoing non-operative management for solid organ injuries at a Brazilian trauma reference hospital between 2018 and 2022. Included were patients with blunt and penetrating trauma, analyzing epidemiological characteristics, blood transfusion, and association with the need for surgical intervention. RESULTS A total of 365 patients were included in the study. Three hundred and forty-three patients were discharged (93.97%), and the success rate of non-operative treatment was 84.6%. There was an association between mortality and the following associated injuries: hemothorax, sternal fracture, aortic dissection, and traumatic brain injury. There was an association between the need for transfusion and surgical intervention. Thirty-eight patients required some form of surgical intervention. CONCLUSION The profile of patients undergoing non-operative treatment consists of young men who are victims of blunt trauma. Non-operative treatment is safe and has a high success rate.
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Affiliation(s)
- Lucas Mansano Sarquis
- - Universidade Federal do Paraná, Clínica Cirúrgica - Curitiba - PR - Brasil
- - Complexo Hospitalar do Trabalhador, Cirurgia Geral e Cirurgia do Trauma - Curitiba - PR - Brasil
| | - Iwan Augusto Collaço
- - Complexo Hospitalar do Trabalhador, Cirurgia Geral e Cirurgia do Trauma - Curitiba - PR - Brasil
| | | | | | - André Tha Nassif
- - Universidade Federal do Paraná, Clínica Cirúrgica - Curitiba - PR - Brasil
| | - Alexandre Coutinho Teixeira DE Freitas
- - Universidade Federal do Paraná, Clínica Cirúrgica - Curitiba - PR - Brasil
- - Complexo Hospitalar do Trabalhador, Cirurgia Geral e Cirurgia do Trauma - Curitiba - PR - Brasil
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Lyons NB, O'Neil CF, Ramsey WA, Bhogadi S, Hosseinpour H, Collie BL, Ginzburg E, Proctor KG, Namias N, Joseph BA, Meizoso JP. Initial Hemorrhage Control Procedure for Splenic Injuries May Affect Risk of Venous Thromboembolism. J Surg Res 2024; 299:255-262. [PMID: 38781735 DOI: 10.1016/j.jss.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Venous thromboembolism (VTE) continues to be a major cause of morbidity in trauma. It is unclear whether the type of hemorrhage control procedure (i.e., splenectomy versus angioembolization) is associated with an increased risk of VTE. We hypothesize that hemodynamically stable patients undergoing angioembolization for blunt high-grade splenic injuries have lower rates of VTE compared to those undergoing splenectomy. METHODS The American College of Surgeons Trauma Quality Program dataset from 2017 to 2019 was queried to identify all patients with American Association for the Surgery of Trauma grade 3-5 blunt splenic injuries. Outcomes including VTE rates were compared between those who were managed with splenectomy versus angioembolization. Propensity score matching (1:1) was performed adjusting for age, sex, initial vital signs, Injury Severity Score, and splenic injury grade. RESULTS The analysis included 4698 matched patients (splenectomy [n = 2349] and angioembolization [n = 2349]). The median (interquartile range) age was 41 (27-58) years and 69% were male. Patients were well matched between groups. Angioembolization was associated with significantly lower VTE than splenectomy (2.2% versus 3.4%, P = 0.010) despite less use of VTE chemoprophylaxis (70% versus 80%, P < 0.001), as well as a relative delay in initiation of chemoprophylaxis (44 h versus 33 h, P < 0.001). Hospital and intensive care unit length of stay and mortality were also significantly lower in the angioembolization group. CONCLUSIONS Angioembolization is associated with a significantly lower incidence of VTE than splenectomy. Thus, angioembolization should be considered for initial management of hemodynamically stable patients with high-grade blunt splenic injuries in whom laparotomy is not otherwise indicated.
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Affiliation(s)
- Nicole B Lyons
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida.
| | - Christopher F O'Neil
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida
| | - Walter A Ramsey
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida
| | - Sai Bhogadi
- Department of Surgery, University of Arizona, Tucson, Arizona
| | | | - Brianna L Collie
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida
| | - Enrique Ginzburg
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida
| | - Kenneth G Proctor
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida
| | - Nicholas Namias
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida
| | - Bellal A Joseph
- Department of Surgery, University of Arizona, Tucson, Arizona
| | - Jonathan P Meizoso
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida
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Lokuhetty N, Philip MT, Paynter JA, Owen AR. A case report of successful splenic artery embolization for atraumatic splenic rupture secondary to Epstein Barr virus infection in a haemodynamically unstable patient. Radiol Case Rep 2024; 19:1970-1974. [PMID: 38434780 PMCID: PMC10909597 DOI: 10.1016/j.radcr.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Splenic rupture in haemodynamically unstable patients has traditionally been managed with splenectomy. This case report discusses the successful management of atraumatic splenic rupture, a rare but life-threatening complication of Epstein-Barr virus (EBV) infection, in a hemodynamically unstable patient. The patient, diagnosed with infectious mononucleosis (IM) secondary to EBV, presented with severe abdominal pain and a syncopal episode. Imaging revealed an American Association for the Surgery of Trauma (AAST) grade III splenic injury, which was subsequently upgraded to a grade IV injury on repeat imaging. The patient's condition deteriorated even with initial resuscitation, leading to splenic angioembolization. The procedure was successful and the patient was discharged after 5 days. This case highlights the efficacy of splenic artery embolization (SAE) in haemodynamically unstable patients with atraumatic splenic rupture, particularly in centers with interventional radiology resources, offering an alternative to splenectomy and its associated complications.
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Yu Q, Zangan S, Funaki B. Preliminary Experience with a Low-Profile High-Density Braid Occluder for Transcatheter Embolization of Pulmonary Arteriovenous Malformations. J Vasc Interv Radiol 2024; 35:32-35.e2. [PMID: 37748577 DOI: 10.1016/j.jvir.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
This brief report describes safety, technical feasibility, and early treatment effectiveness of the low-profile braided occluder (LOBO; Okami Medical, San Diego, Caliornia) for embolization of 9 pulmonary arteriovenous malformations (PAVMs) in 4 patients (3 female and 1 male; age range: 33 to 63 years; 3 patients showed positive results for hereditary hemorrhagic telangiectasia genes). A total of 10 occluders were deployed in 10 vessels (median treated vessel diameters, 3 and 4 mm for LOBO-3 and LOBO-5 groups, respectively). All devices were successfully deployed into the feeder pulmonary arteries, achieving complete cessation of flow. There were no severe adverse events or device migrations. Available short-term follow-up computed tomography (6 PAVMs: median, 7 months; range, 1.5-7 months) demonstrated complete occlusion without persistence or recanalization. The early experience of embolization of PAVMs using a low-profile braided occluder showed it to be safe and effective. Further studies with larger cohorts and longer follow-up periods are warranted.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
| | - Steven Zangan
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Brian Funaki
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
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Ichiyama S, Ishizawa Y, Washida K, Kakehata S, Kakeda S. Gastric Artery Injury Due to Blunt Abdominal Trauma. Cureus 2023; 15:e50018. [PMID: 38186483 PMCID: PMC10767424 DOI: 10.7759/cureus.50018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Gastric artery injury resulting from blunt abdominal trauma is rare, with only eight previous cases documented in the published literature. Our report describes a case involving an injury to the right gastric artery with concomitant injuries to the liver and spleen, for which arterial embolization targeting the right gastric artery was performed. The patient, a 66-year-old woman without any remarkable medical history, was involved in a motor vehicle accident. She was brought to the hospital in a state of shock and complaining of upper abdominal pain. Contrast-enhanced CT indicated hepatic and splenic injuries, intra-abdominal hemorrhaging, and effusion of contrast medium, suggesting involvement of the right gastric artery. Subsequent angiography confirmed irregularities in the diameter of the right gastric artery, prompting coil embolization. A conservative therapeutic approach was selected due to the absence of evidence regarding active hemorrhage or vascular injury within the hepatic or splenic regions. The patient remained clinically stable following the embolization, without any sequelae. Arterial embolization is warranted if preoperative contrast CT indicates signs of hemorrhage, even if hemostasis is ostensibly attained during angiography. Our findings allude to the feasibility of non-operative management (NOM) rather than laparotomy for cases of gastric artery injury.
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Affiliation(s)
- Saaya Ichiyama
- Emergency and Disaster Medicine, Hirosaki University, Hiorosaki, JPN
- Emergency and Critical Care Center, Aomori Prefectural Central Hospital, Aomori, JPN
| | - Yoshiya Ishizawa
- Emergency and Critical Care Center, Aomori Prefectural Central Hospital, Aomori, JPN
| | - Keisuke Washida
- Emergency and Critical Care Center, Aomori Prefectural Central Hospital, Aomori, JPN
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Xu SS, Eng K, Accorsi F, Cool DW, Wiseman D, Mujoomdar A, Cardarelli-Leite L. Proximal splenic artery embolization using a vascular plug in grade IV or V splenic trauma - a single centre 11-year experience. CVIR Endovasc 2023; 6:1. [PMID: 36627472 PMCID: PMC9832195 DOI: 10.1186/s42155-022-00345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Samuel S. Xu
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada ,Halton Healthcare Services, 3001 Hospital Gate, Oakville, ON L6M 0L8 Canada
| | - Kevin Eng
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
| | - Fabio Accorsi
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
| | - Derek W. Cool
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
| | - Daniele Wiseman
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
| | - Amol Mujoomdar
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, Ontario Canada
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Tran S, Wilks M, Dawson J. Endovascular Management of Splenic Trauma. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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