Trauma splenic

In 1998, the FDA approved fibrin sealant for three specific indications. These include hemostasis at the time of cardiac surgical operations [8] (Fig. 2) as well as at the time of operative procedures to treat splenic trauma. The application of the fibrin sealant which consists of normal biologic components in the body s clotting cascade creates a localized clot which further enhances inherent clotting ability. Although approved for these specific hemostatic indications only, fibrin sealant is useful as a hemostat in a wide variety of off-label clinical situations as well [9,10]. These include such applications as hemostasis for liver trauma or resection [11], vascular anastomoses [12], tonsillectomy [13], peripheral joint replacement [14], dental extractions [15], and bum debridement [16]. 

The most extensive experience with tissue adhesive drug delivery exists in the fibrin sealant literature. This is clearly an off-label use of this agent as it is only currently approved for hemostasis in cardiac and splenic trauma surgery and for colon sealing at the time of colostomy closure. 

In splenic trauma, with a life-long increased risk of sepsis after splenectomy, non-operative treatment is the management of choice. In several studies the efficacy of TAE has been shown to be over 90% (Hagiwara et al. 1996). Embolization of the splenic artery, distal to the pancreatic artery, leads to splenic preservation resulting from collateriza-tion by pancreatic and gastric branches. 

The role of diagnostic angiography in the evaluation of patients experiencing blunt splenic trauma... 

It must be stated that the goal of embolization in the setting of splenic trauma is to reduce arterial flow to the spleen so that hemostasis can take place at the site of arterial injury. However, the importance of maintaining splenic viability must not be forgotten and therefore, continued perfusion of splenic parenchyma from collateral vessels must also be maintained during a successful embolization procedure. 

Haan et al. also reported the results of a multicenter review of patients undergoing splenic artery embolization for splenic trauma and this represents the largest collection of splenic artery embolization patients studied to date [2]. In this review, 140 patients undergoing splenic artery embolization at... 

Killeen KL, Shanmuganathan K, Boyd-Kranis R et al. (2001) CT findings after embolization for blunt splenic trauma. J Vase Interv Radiol 12 209-214... 

Lucas CE (1991) Splenic trauma choice of management. Ann Surg 213 98-112... 

Koury HI, Peschiera JL, Welling RE (1991) Non-operative management of blunt splenic trauma a 10-year experience. Injury 22 349-352... 

Mirvis SE, Whitley NO, Gens DR (1989) Blunt splenic trauma in adults CT-based classification and correlation with prognosis and treatment. Radiology 171 33-39... 

Umlas SL, Cronan JJ (1991) Splenic trauma can CT grading systems enable prediction of successful nonsurgical treatment Radiology 178 481-485... 

Resciniti A, Flink MP, Raptopoulous V et al. (1988) Nonoperative treatment of adult splenic trauma development of a computed tomographic scoring system that detects appropriate candidates for expectant management. J Trauma 28 828-831... 

Becker CD, Spring P, Glatth A et al. (1994) Blunt splenic trauma in adults can CT findings he used to determine the need for surgery AJR 162 343-347... 

Gaunt WT, McCarthy MC, Lamhert CS et al. (1999) Traditional criteria for ohservation of splenic trauma should he challenged. Am Surg 65 689-691... 

Cocanour CS, Moore FA, Ware DN et al. (1998) Delayed complications of nonoperative management of blunt adult splenic trauma. Arch Surg 1998 133 619-625... 

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