Treatment Options for Aneurysms

In this episode, Dr. Aaron Fritts interviews Dr. Chris Grilli of Christiana Health about his treatment algorithms and procedural tips for splenic embolization as a treatment for splenic trauma, hypersplenism, and splenic artery aneurysm.

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SHOW NOTES

Dr. Grilli explains that the most common indication for splenic embolization is trauma. He walks us through different trauma guidelines for grading splenic trauma. At his institution, if only a small portion of parenchyma is involved, the patient is monitored. If significant trauma and vascular injury is present and the patient is mostly stable, the patient gets referred to IR. Dr. Grilli notes that the decision to refer to IR or trauma surgery is also institutionally dependent. Across most institutions, it is more common to monitor pediatric splenic trauma rather than intervene.

Next. Dr. Grilli walks us through an embolization for splenic trauma. He will most often opt for femoral access, unless there is underlying pathology or very large body habitus. He uses a 5Fr sheath and then navigates to the splenic artery with a C2 angiographic catheter. Then, he performs angiography to visualize the bleed, decide if he wants to embolize proximally or distally, and chooses his embolic agent.

The doctors discuss pros and cons of using plugs, coils, and liquid embolics. Coils can induce stasis more quickly than a plug can. There are also coils with different materials and mechanisms of deployment. Dr. Grilli notes that an angiographic run at the end of an ideal case would show that the embolic device has obstructed flow in the main artery and the spleen is now being perfused by collaterals.

Finally, we address non-traumatic indications for splenic embolization. In hypersplenism, oncologists will refer patients to IR to address platelet sequestration. Dr. Grilli says that these cases require embolization of segmental branches of the splenic artery, in the effort to kill off 40-70% of the spleen. This procedure could introduce significant adverse effects that must be discussed with the patient beforehand. In embolization of splenic artery aneurysms, Dr. Grilli prefers to use long packing coils or covered stents.

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RESOURCES

ChristianaCare IR Residency:

https://residency.christianacare.org/vascular-interventional-radiology

AAST Spleen Injury Scale:

https://www.aast.org/resources-detail/injury-scoring-scale#spleen

WSES Classification and Guidelines for Splenic Trauma:

https://pubmed.ncbi.nlm.nih.gov/28828034/

Cobra 2 (C2) Catheter:

https://meritoem.com/product-category/catheters-extrusions/diagnostic-peripheral/performa-impress/cobra-2/

Sarah Catheter:

https://www.terumois.com/products/catheters/optitorque.html

Penumbra Pod Device:

https://www.penumbrainc.com/peripheral-device/pod/

Embold Fibered Coil:

https://www.bostonscientific.com/en-US/products/embolization/embold-detachable-coil-system.html

Interlock Coil:

https://www.bostonscientific.com/en-US/products/embolization/interlock-and-idc-detachable-embolization-coils.html

Management of Hypersplenism by Partial Splenic Embolization With Ethylene Vinyl Alcohol Copolymer (Onyx):

https://www.ajronline.org/doi/full/10.2214/AJR.10.4401?mobileUi=0

MYNXGRIP Closure Device:

https://cordis.com/na/products/close/endovascular/mynxgrip-vascular-closure-device

AngioSeal Closure Device:

https://www.terumois.com/products/closure/angio-seal-vascular-closure-devices/angio-seal.html

CELT Closure Device:

https://www.veryanmed.com/usa/products/celt-acd-vascular-closure-device/