Splenic artery embolization

Role of embolization in splenic trauma

In mechanical injury of the spleen, the primary task of diagnostic radiology is to assess the scale of hemorrhage. In such cases, a coronal CT angiogram typically visualizes a massive perisplenic hematoma. Selective catheterization of the vascular bed is performed for precise topical diagnosis and subsequent treatment.

During the diagnostic angiogram stage, the physician identifies characteristic pathological changes: the contours of the splenic vessels become irregular, and a pronounced divergence of branches is observed. Treatment tactics consist of performing embolization using a specialized device, the vascular plug. The key advantage of this method is that after the plug is deployed, blood flow to the splenic parenchyma does not cease completely. Tissues continue to receive oxygen and nutrients through a collateral network, in the formation of which the dorsal pancreatic artery actively participates. This contributes to the complete preservation of organ function.

Principles of treatment for arterial thrombosis

Endovascular surgery is not limited to emergency interventions for trauma. An important aspect is the treatment of occlusive lesions caused by thrombotic masses. Following successful clearance (thrombus removal), a primary pathological wall lesion is often discovered within the vessel lumen. To prevent recurrence, balloon angioplasty or stent implantation must be performed during the same procedure.

The evolution of pharmacological thrombus dissolution is interesting. About 15–25 years ago, thrombolysis was considered one of the most popular methods for treating acute lower limb ischemia. However, in modern clinical practice, it is used significantly less often. This is due to the high risk of associated bleeding. Today, thrombolysis remains in the physicians' arsenal only for treating carefully selected patient categories.

Angiographic anatomy of pelvic and leg arteries

To understand the localization of vascular pathologies, it is necessary to clearly know the topography of the arterial bed. Branching begins at the level of the L4 vertebra, where the abdominal aorta bifurcates into two common iliac arteries (a. iliaca communis). They descend anterior to the veins of the same name and do not give off major branches in this segment.

• Level of the mid-sacrum: the common iliac artery divides into the internal (a. iliaca interna) and external (a. iliaca externa) iliac arteries. The internal artery supplies pelvic structures (the anterior branch goes to the internal organs, the posterior branch to the musculature). The external branch passes in transit to the thigh, giving off only the inferior epigastric artery (a. epigastrica inferior).
• Level of the inguinal ligament: the external iliac artery continues into the short trunk of the common femoral artery (a. femoralis communis). It, in turn, divides into the deep femoral artery (a. profunda femoris, which supplies the muscles) and the superficial femoral artery (SFA), which descends distally.
• Adductor canal (Hunter's canal): here the SFA continues as the popliteal artery (a. poplitea).
• Leg: the popliteal artery gives rise to the vessels of the leg — the anterior and posterior tibial arteries (a. tibialis anterior et posterior), as well as the fibular artery (a. peronea / fibularis). The anterior tibial artery occupies the most lateral position, while the posterior tibial artery occupies the most medial.
• Ankle level and foot: the anterior tibial artery continues into the dorsalis pedis artery (a. dorsalis pedis), and the posterior tibial artery divides into the medial and lateral plantar arteries (a. plantaris medialis et lateralis). The plantar arch is formed by the union of the lateral plantar branch and the dorsalis pedis artery.

Pathologies and clinical presentation of ischemia

The main problem of lower limb arteries is the development of tissue ischemia against the background of stenosing or occlusive processes. Occlusion can be acute, chronic, or develop in a mixed pattern (acute-on-chronic, when acute thrombosis is superimposed on a prior stenosis).

Most often, the cause is atherosclerosis, affecting vessels at any level — from the iliacs to the small arteries of the foot. Less common causes include thromboembolism, compression syndromes, vasculitis, cystic adventitial disease, and Buerger's disease.

The clinical presentation varies:

1. Asymptomatic course.
2. Intermittent claudication: pain occurs during walking. It is usually managed conservatively. Surgical treatment is indicated only for an extremely short pain-free walking distance, inefficacy of exercise therapy, and a severe reduction in quality of life.
3. Critical ischemia: accompanied by rest pain and tissue loss (ulcers, gangrene). Requires mandatory surgical or endovascular intervention to avoid amputation.

History-taking plays a decisive role in diagnosis. For example, sudden sharp leg pain in a person without a history of vascular disease indicates an acute embolus in the femoral or popliteal artery. The presence of diabetes mellitus makes one suspect isolated disease of the distal leg and foot bed. And prior radiation therapy (e.g., for cervical cancer) can be the cause of radiation-induced vasculitis and iliac artery occlusion.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Assessment of collateral blood flow in parenchymal organ trauma
• Types of vascular occluders (vascular plugs) and their implantation technique
• Endovascular treatment of critical lower extremity ischemia
• Radiation-induced vasculitis: pathogenesis and angiographic presentation
• Acute thromboembolism of the femoral and popliteal arteries

Other topics in the "Interventional radiology" section

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