Bundy Jacob J, Hage Anthony N, Srinivasa Ravi N, Gemmete Joseph J, Srinivasa Rajiv N, Jairath Neil, Anand Rohit, Dasika Narasimham, Lee Eunjee, Chick Jeffrey Forris Beecham
Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America.
Department of Radiology, Division of Interventional Radiology, University of California Los Angeles, 757 Western Plaza, Los Angeles, CA 90095, United States of America.
Clin Imaging. 2019 Mar-Apr;54:6-11. doi: 10.1016/j.clinimag.2018.10.005. Epub 2018 Oct 3.
Splenic abscesses represent a major complication following splenic artery embolization. The purpose of this study was to assess the effectiveness of intra-arterial antibiotics administered during splenic artery embolization in reducing splenic abscess formation.
406 patients were screened. 313 (77.1%) patients who underwent splenic artery embolization and were >18 years old were included. Mean age of the cohort was 58 ± 15 years (range: 18-88 years). There were 205 (65.5%) male patients and 108 (34.5%) female patients. 197 (62.9%) patients underwent embolization without intra-arterial antibiotics and 116 (37.1%) patients underwent embolization with 1 g ampicillin and 80 mg gentamicin administered in an intra-arterial fashion. Primary outcome was splenic abscess formation. Secondary outcomes included type of splenic artery embolization, embolic agent, and technical success.
Partial splenic embolization was performed in 229 (73.1%) patients. Total splenic embolization was performed in 84 (26.8%) patients. Platinum coils were the most commonly used embolic agent overall (n = 178; 56.9%) followed by particulates (n = 114; 36.4%). Embolization technical success was achieved in 312 (99.7%) patients. 7 (3.6%) splenic abscesses were detected in the non-intra-arterial antibiotic group and 1 (0.9%) in the intra-arterial antibiotic cohort (P = 0.27). Coils were found to be statistically more likely to result in splenic abscesses than any other embolic agent (P = 0.03). Mean time to abscess identification was 74 days ±120 days (range: 9-1353 days).
Splenic abscesses occurred more frequently in patients who did not receive intra-arterial antibiotics during splenic embolization; however, this did not reach statistical significance.
脾脓肿是脾动脉栓塞术后的一种主要并发症。本研究的目的是评估在脾动脉栓塞期间动脉内给予抗生素在减少脾脓肿形成方面的有效性。
对406例患者进行筛查。纳入313例（77.1%）接受脾动脉栓塞且年龄大于18岁的患者。该队列的平均年龄为58±15岁（范围：18 - 88岁）。男性患者205例（65.5%），女性患者108例（34.5%）。197例（62.9%）患者在未进行动脉内抗生素治疗的情况下接受栓塞，116例（37.1%）患者在动脉内给予1g氨苄西林和80mg庆大霉素后接受栓塞。主要结局是脾脓肿形成。次要结局包括脾动脉栓塞类型、栓塞剂和技术成功率。
229例（73.1%）患者进行了部分脾栓塞。84例（26.8%）患者进行了全脾栓塞。铂圈是总体上最常用的栓塞剂（n = 178；56.9%），其次是微粒（n = 114；36.4%）。312例（99.7%）患者实现了栓塞技术成功。在非动脉内抗生素组中检测到7例（3.6%）脾脓肿，在动脉内抗生素队列中检测到1例（0.9%）（P = 0.27）。发现与任何其他栓塞剂相比，铂圈在统计学上更有可能导致脾脓肿（P = 0.03）。脓肿识别的平均时间为74天±120天（范围：9 - 1353天）。
在脾栓塞期间未接受动脉内抗生素治疗的患者中，脾脓肿发生得更频繁；然而，这未达到统计学意义。
