Therapeutic strategies for pseudoaneurysm following blunt liver and spleen injuries: A multicenter cohort study in the pediatric population. Issue 3 (17th March 2023)

• Record Type: Journal Article
• Authors: Katsura, Morihiro; Kondo, Yutaka; Yasuda, Hideto; Fukuma, Shingo; Matsushima, Kazuhide; Shiraishi, Atsushi; Tsuchiya, Asuka; Kuriyama, Akira; Gima, Masafumi; Hayashida, Kazuyuki; Miura, Naoya; Sugiura, Kenta; Toma, Keiichiro; Yasumatsu, Hiroshi; Kushimoto, Shigeki
• Other Names: Ito Tomoya author non-byline.; Yamamoto Motoyoshi author non-byline.; Yamamoto Yoshihiro author non-byline.; Manase Hiroto author non-byline.; Takahashi Nozomi author non-byline.; Osuka Akinori author non-byline.; Annen Suguru author non-byline.; Ishikawa Nobuki author non-byline.; Takayama Kazushi author non-byline.; Minowa Keita author non-byline.; Hakamada Kenichi author non-byline.; Kusaka Akari author non-byline.; Hayakawa Mineji author non-byline.; Kawahara Shota author non-byline.; Hirano Satoshi author non-byline.; Matsumoto Marika author non-byline.; Kusumoto Kohei author non-byline.; Kodaira Hiroshi author non-byline.; Kunishige Chika author non-byline.; Toma Keiichiro author non-byline.; Seino Yusuke author non-byline.; Kobayashi Michio author non-byline.; Sakuraya Masaaki author non-byline.; Shinjo Takafumi author non-byline.; Ono Shigeru author non-byline.; Yasuda Hideto author non-byline.; Taira Haruka author non-byline.; Omori Kazuhiko author non-byline.; Kondo Yutaka author non-byline.; Kamimura Yoshio author non-byline.; Shiraishi Atsushi author non-byline.; Tanaka Rei author non-byline.; Tsuzuki Yukihiro author non-byline.; Sato Yukio author non-byline.; Kyogoku Noriaki author non-byline.; Onishi Masafumi author non-byline.; Kawai Kaichi author non-byline.; Hayashida Kazuyuki author non-byline.; Terazumi Keiko author non-byline.; Kuriyama Akira author non-byline.; Matsushime Susumu author non-byline.; Takasu Osamu author non-byline.; Morita Toshio author non-byline.; Sato Nagato author non-byline.; Ishii Wataru author non-byline.; Miyaguni Michitaro author non-byline.; Fukuma Shingo author non-byline.; Nakabayashi Yosuke author non-byline.; Ohtaki Yoshimi author non-byline.; Murata Kiyoshi author non-byline.; Yagi Masayuki author non-byline.; Kaneko Tadashi author non-byline.; Takamizawa Shigeru author non-byline.; Yasui Akihiro author non-byline.; Mayama Yasuaki author non-byline.; Gima Masafumi author non-byline.; Okada Ichiro author non-byline.; Tsuchiya Asuka author non-byline.; Ishigami Koji author non-byline.; Masuda Yukiko author non-byline.; Yamada Yasuo author non-byline.; Yasumatsu Hiroshi author non-byline.; Shigeta Kenta author non-byline.; Kato Kohei author non-byline.; Ito Fumihito author non-byline.; Iida Atsuyoshi author non-byline.; Yumoto Tetsuya author non-byline.; Naito Hiromichi author non-byline.; Katsura Morihiro author non-byline.; Saegusa Yoshitaka author non-byline.; Azuma Tomohiko author non-byline.; Asano Shima author non-byline.; Umemura Takehiro author non-byline.; Goto Norihiro author non-byline.; Yamamoto Takao author non-byline.; Ishikawa Junichi author non-byline.; Uebayashi Elena Yukie author non-byline.; Nakao Shunichiro author non-byline.; Ogawa Yuko author non-byline.; Irinoda Takashi author non-byline.; Narumi Yuki author non-byline.; Asahi Miho author non-byline.; Ogura Takayuki author non-byline.; Hazama Takashi author non-byline.; Matsumoto Shokei author non-byline.; Miyamoto Daisuke author non-byline.; Harada Keisuke author non-byline.; Kubota Narumi author non-byline.; Konda Yusuke author non-byline.; Asai Takeshi author non-byline.; Muronoi Tomohiro author non-byline.; Matsushima Kazuhide author non-byline.; Hifumi Toru author non-byline.; Shirasaki Kasumi author non-byline.; Furuta Shigeyuki author non-byline.; Fujikawa Atsuko author non-byline.; Takaoka Makoto author non-byline.; Ito Kaori author non-byline.; Nara Satoshi author non-byline.; Kushimoto Shigeki author non-byline.; Tanikawa Atsushi author non-byline.; Tsuchikane Masato author non-byline.; Miura Naoya author non-byline.; Sakoda Naoki author non-byline.; Takada Tadaaki author non-byline.; Shirane Shogo author non-byline.; Endo Akira author non-byline.; Nakatsutsumi Keita author non-byline.; Sugiura Kenta author non-byline.; Hagiwara Yusuke author non-byline.; Gotou Tamotsu author non-byline.;
• Is Part Of: Journal of trauma and acute care surgery. Volume 94:Issue 3(2023)
• Page Start: 433
• Page End: 442
• Publication Date: 2023-03-17
• Subjects: Spleen injury -- liver injury -- interventional radiology -- pseudoaneurysm -- children; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003813
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : This multicenter retrospective cohort study from Japan found that children who sustained blunt liver and/or spleen injury of any grade has a potential risk of delayed pseudoaneurysm development and rupture even after the early phase of interventional radiology. Abstract : BACKGROUND: Little guidance exists for the treatment of pseudoaneurysm (PA) following pediatric blunt liver and/or spleen injuries (BLSIs). We aimed to describe the incidence of delayed PA development and the subsequent clinical course of PA in pediatric BLSIs. METHODS: This multicenter retrospective cohort study from Japan included pediatric patients (16 years and younger) who sustained BLSIs from 2008 to 2019. The cohort was divided into four groups based on hemostatic intervention within 48 hours of admission, namely, nonoperative management (NOM), NOM with interventional radiology (IR), operative management (OM), and combined IR/OM. Descriptive statistics were used to describe the incidence of delayed PA among the groups and to characterize the clinical course of any PAs. RESULTS: A total of 1, 407 children (median age, 9 years) from 83 institutions were included. The overall number (incidence) of cases of delayed PA formation was 80 (5.7%), and the number with delayed PA rupture was 16 cases (1.1%) in the entire cohort. Patients treated with NOM (1, 056), NOM with IR (276), OM (53), and combined IR/OM (22) developed 43 (4.1%), 32 (12%), 2 (3.8%), and 3 (14%) delayed PAs, respectively. Among patients who developed any PAs, 39% of patients underwent prophylactic IR for unruptured PA, while 13% required emergency angioembolization for delayed PA rupture, with one ruptured case requiring total splenectomy. At least 45% of patients experienced spontaneous resolution of PA without any interventions. CONCLUSION: Our results suggest that the risk of delayed PA still exists even after acute phase IR as an adjunct to NOM for BLSIs in children, indicating the necessity of a period of further observation. While endovascular interventions are usually successful for PA management, including rupture cases, given the high incidence of spontaneous resolution, the ideal management of PA remains to be investigated in future studies. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV. Abstract :