Proximal embolization of splenic artery in acute trauma: Comparison between Penumbra occlusion device versus coils or Amplatzer vascular plug.

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.