Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France.
Department of Radiology, Haut-Leveque University Hospital Center, avenue Magellan, 33600 Pessac, France; Department of Radiology, University Hospital Center, 46, rue du Bugnon, 1011 Lausanne, Switzerland.
Diagn Interv Imaging. 2018 Dec;99(12):801-808. doi: 10.1016/j.diii.2018.05.012. Epub 2018 Jun 15.
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).
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.
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.
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.
比较使用 Penumbra 闭塞装置（POD）、线圈或 Amplatzer™ 血管塞（AVP）对急性创伤患者进行脾动脉近端栓塞的介入时间和透视时间。
共回顾性纳入 29 例无血管损伤的脾损伤患者，采用 POD（n=12）、线圈（n=9）或 AVP（n=8）行脾动脉近端栓塞治疗。患者包括 25 名男性和 4 名女性，中位年龄 34 岁（范围：10-69 岁）。为了克服治疗选择中的偏倚，使用逆概率加权法计算倾向评分。比较介入时间和透视时间、治疗成功率和并发症。
与使用线圈（60min）相比，使用 POD（30min）或 AVP（47min）的介入时间明显更短（P=0.0001 和 0.004）。与使用线圈（23.6min）或 AVP（16.5min）相比，使用 POD 的透视时间明显更低（P=0.0076 和 0.049）。POD 和 AVP 的主要疗效率为 100%，线圈为 89%（P=0.586）。POD 发生 6 例并发症，平均随访 12 个月；线圈发生 1 例并发症，平均随访 32 个月；AVP 发生 1 例并发症，平均随访 40 个月。POD 并发症包括 2 例脓肿，经抗生素治疗；1 例脓肿，经 AVP 治疗；2 例线圈迁移；1 例线圈拆除，无不良后果。
与传统金属线圈相比，POD 和 AVP 可用于急性创伤患者的脾动脉近端栓塞，介入时间更短，技术成功率相似。与线圈或 AVP 相比，POD 的透视时间更短。
