Authors: P T Foley H Kavnoudias P U Cameron C Czarnecki E Paul S M Lyon
Publish Date: 2015/07/03
Volume: 38, Issue: 5, Pages: 1143-1151
Abstract
Patients with splenic trauma who were treated by splenic artery embolisation SAE were enrolled After 6 months splenic volume was assessed by CT and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a postsplenectomy populationOf the 71 patients who underwent embolisation 38 underwent proximal embolisation 11 underwent distal embolisation 22 patients were excluded 1 had both proximal and distal embolisation 5 did not survive and 16 did not return for evaluation There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age grade of injury or residual splenic volumeIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better functionSplenic artery embolisation SAE has been shown to increase the rate of splenic conservation following trauma 1 2 3 4 5 6 and is frequently performed as an adjunct to nonoperative management of blunt splenic injury which is now the standard of care in haemodynamically stable patients 7 8 9 10Recently IgM memory B cells have been shown to play a role in the innate response to encapsulated bacteria through T cellindependent production of IgM antibodies IgM memory B cells depend on the spleen for development and are reduced in number in the peripheral blood of splenectomised patients A lack of IgM memory B cells is associated with increased vulnerability of postsplenectomy patients to pneumococcal infectionsTwo methods of splenic artery embolisation have been described proximal embolisation to occlude the splenic artery proximal to the spleen reducing perfusion pressure but allowing splenic perfusion via collaterals distal embolisation to occlude the bleeding vessel within the spleen usually resulting in infarction of the tissue distal to the embolisation but with normal perfusion pressure to the remaining spleen The effects of these different methods on splenic immune function have not been previously evaluated
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