Morrison Chet A, Gross Brian W, Kauffman Matthew, Rittenhouse Katelyn J, Rogers Frederick B
Am Surg. 2017 Jun 1;83(6):554-558.
The delayed development of splenic artery pseudoaneurysm (SAP) can complicate the nonoperative management of splenic injuries. We sought to determine the utility of repeat imaging in diagnosing SAP in patients managed nonoperatively without angioembolization. We hypothesized that a significant rate of SAPs would be found in this population on repeat imaging. Patients undergoing nonoperative splenic injury management from January 2011 to June 2015 were queried from the trauma registry. Rates of repeat imaging, angioembolization, readmission, and SAP development were analyzed. Further, subanalyses investigating the incidence of SAP in patients managed nonoperatively without angioembolization were conducted. A total of 133 patients met inclusion criteria. Repeat imaging rate was 40 per cent, angioembolization rate was 26 per cent, and readmission rate was 6 per cent. Within the study population, nine SAPs were found (8/9 in patients with splenic injury grade ≥III). Of these nine SAPs, three (33%) were identified on initial scans and embolized, whereas six (67%) were found on repeat imaging in patients not initially receiving angioembolization. Splenic injuries are typically managed nonoperatively without serious complications. Our results suggest patients with splenic injuries grade ≥III managed nonoperatively without angioembolization should have repeat imaging within 48 hours to rule out the possibility of SAP.
脾动脉假性动脉瘤（SAP）的延迟发生会使脾损伤的非手术治疗变得复杂。我们试图确定在未进行血管栓塞的非手术治疗患者中，重复成像对诊断SAP的效用。我们假设在这一人群中，重复成像会发现相当比例的SAP。从创伤登记处查询了2011年1月至2015年6月接受非手术脾损伤治疗的患者。分析了重复成像、血管栓塞、再次入院和SAP发生的比率。此外，还进行了亚分析，调查未进行血管栓塞的非手术治疗患者中SAP的发生率。共有133例患者符合纳入标准。重复成像率为40%，血管栓塞率为26%，再次入院率为6%。在研究人群中，发现了9例SAP（脾损伤≥III级的患者中有8/9例）。在这9例SAP中，3例（33%）在初次扫描时被发现并进行了栓塞，而6例（67%）是在未接受血管栓塞的患者重复成像时发现的。脾损伤通常采用非手术治疗，且无严重并发症。我们的结果表明，未进行血管栓塞的非手术治疗的脾损伤≥III级患者应在48小时内进行重复成像，以排除SAP的可能性。
