Proximal Embolization of Splenic Artery in Acute Trauma: Comparison Between Penumbra Occlusion Device Versus Coils or Amplatzer Vascular Plug

Diagn Interv Imaging. 2018 Dec;99(12):801-808. doi: 10.1016/j.diii.2018.05.012. Epub 2018 Jun 15.

Abstract

Purpose: To compare intervention duration and fluoroscopy time for proximal embolization of splenic arteries in acute trauma using the Penumbra occlusion device (POD®), coils or Amplatzer™ vascular plug (AVP).

Material and methods: A total of 29 patients with splenic injury without vascular injury who were treated by proximal splenic artery embolization using POD® (n=12), coils (n=9) or AVP (n=8) were retrospectively included. There were 25 men and 4 women with a median age of 34 years (range: 10-69 years). To overcome bias in treatment choice, a propensity score was used using inverse probability weighting. Intervention duration and fluoroscopy time, treatment success and complications were compared.

Results: The median intervention duration was significantly shorter using POD® (30min) or AVP (47min) than using coils (60min) (P=0.0001 and 0.004, respectively). The median fluoroscopy time was significantly lower using POD® (11.5min) than using coils (23.6min) (P=0.0076) or AVP (16.5min) (P=0.049). The primary efficacy rate was 100% with POD® and AVP and 89% with coils (P=0.586). Six complications occurred with a mean follow-up of 12 months for POD®, 32 months for coils and 40 months for AVP, consisting in 2 abscesses treated by anti-biotherapy with POD®, one abscess with AVP, 2 material migrations with coils and 1 coil dismantled without consequence.

Conclusion: POD® and AVP allow proximal embolization of splenic artery in acute trauma with shorter intervention duration by comparison with conventional metallic coils with similar technical success. POD® allows a shorter fluoroscopy time than coils or AVP.

Keywords: Amplatzer™ vascular plug; Embolization; Interventional radiology; Irradiation; Penumbra(®) occlusion device; Splenic trauma.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Embolization, Therapeutic / instrumentation*
  • Embolization, Therapeutic / methods
  • Female
  • Fluoroscopy
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Radiography, Interventional
  • Retrospective Studies
  • Septal Occluder Device*
  • Spleen / injuries*
  • Splenic Artery*
  • Time Factors
  • Young Adult