Widlus David M, Moeslein Fred M, Richard Howard M
Division of Interventional Radiology, Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
J Vasc Interv Radiol. 2008 May;19(5):652-6. doi: 10.1016/j.jvir.2007.11.025. Epub 2008 Mar 17.
Proximal splenic artery embolization is performed for splenic salvage in the setting of trauma or before splenectomy in patients with splenomegaly. Typically, this has been done with the use of metallic coils, but precise placement of the first deposited coil may be limited. The Amplatzer vascular plug (AVP) may be used to accomplish precise proximal splenic artery embolization.
Fourteen patients had proximal splenic artery embolization performed with the AVP. Thirteen were performed to allow splenic salvage after blunt trauma and one was performed before splenectomy for massive splenomegaly. Devices ranging in diameter from 8 to 12 mm were placed through 5-F or 6-F guiding catheters. Desired AVP location was distal to the dorsal pancreatic artery and proximal to the most peripheral pancreatica magna branch. Test injections of contrast agent were performed after approximately 5 minutes and then at 3-5-minute intervals until occlusion was seen. If this was not noted by 15 minutes, an adjunctive closure method was chosen. Computed tomography (CT) follow-up was performed in all patients.
Device placement in the desired location was successful in all cases, with device repositioning required in two. Occlusion took an average of approximately 10 minutes. Additional coils placed in three patients could all be packed into a tight configuration. A second AVP was placed in one patient. There were no complications of the procedures. Follow-up CT images showed no evidence of migration or recanalization of any of the devices. Minimal artifact was noted from the AVP on CT.
In this preliminary series, use of the AVP allowed for precise proximal splenic artery embolization.
在创伤情况下进行近端脾动脉栓塞以挽救脾脏，或在脾肿大患者行脾切除术之前进行。通常，这是通过使用金属线圈来完成的，但第一个放置的线圈的精确放置可能会受到限制。Amplatzer血管封堵器（AVP）可用于完成精确的近端脾动脉栓塞。
14例患者使用AVP进行近端脾动脉栓塞。13例是在钝性创伤后为挽救脾脏而进行的，1例是在因巨大脾肿大行脾切除术之前进行的。通过5F或6F引导导管放置直径为8至12mm的装置。期望的AVP位置在胰背动脉远端且在最外周的胰大动脉分支近端。大约5分钟后进行造影剂试验注射，然后每隔3至5分钟进行一次，直到观察到闭塞。如果15分钟内未观察到闭塞，则选择辅助封堵方法。所有患者均进行了计算机断层扫描（CT）随访。
所有病例中装置均成功放置在期望位置，2例需要重新定位装置。闭塞平均需要约10分钟。3例患者放置的额外线圈均能紧密排列。1例患者放置了第二个AVP。手术无并发症。随访CT图像显示没有任何装置迁移或再通的证据。CT上AVP产生的伪影最小。
在这个初步系列研究中，使用AVP可实现精确的近端脾动脉栓塞。
