目的:本系统综述旨在阐明影像学技术在识别非闭塞性肝动脉灌注不足综合征(NOHAH)方面的诊断能力,并评估脾动脉栓塞(SAE)的疗效和结果。包括栓塞剂的选择和放置。
方法:使用PubMed进行了全面的文献检索,CINAHL,和Scopus数据库,遵守PRISMA准则。分析了15项研究,包括240例接受栓塞治疗的患者(使用线圈或Amplatzer血管塞(AVP))。评估的关键指标包括患者人口统计,栓塞技术,栓塞剂,技术上的成功,栓塞前后的放射学发现,和并发症发生率。
结果:在研究的240名患者中,177(73.8%)按性别报告,大多数是男性(127/177,71.7%)。在80%的研究中,多普勒超声(DUS)成为主要的初始筛查工具。肝动脉阻力指数(RI)是一个关键参数,平均值从栓塞前的0.84降至栓塞后的0.70(p<0.001)。所有病例通过数字减影血管造影证实技术成功,显示肝动脉充盈延迟,无狭窄或血栓形成。线圈是主要的栓塞剂,用于80.8%的患者,其次是AVP,占16.3%。总死亡率为4.58%,29个主要并发症和3个次要并发症。值得注意的是,与远端放置相比,近端放置脾动脉线圈的死亡率较低,并且显示出与AVPs相当的并发症发生率.
结论:DUS是NOHAH的可靠筛查方式,SAE后评估显示显着改善。栓塞的选择和位置显着影响患者的预后,由于较低的死亡率和与替代方法相当的并发症情况,线圈的近端放置成为一种优选的策略。
OBJECTIVE: This systematic review aims to elucidate the diagnostic capabilities of imaging techniques in identifying Non-Occlusive Hepatic Artery Hypoperfusion Syndrome (NOHAH) and to evaluate the efficacy and outcomes of splenic artery embolization (SAE), including the choice and placement of embolic agents.
METHODS: A comprehensive literature search was conducted using PubMed, CINAHL, and Scopus databases, adhering to PRISMA guidelines. Fifteen studies encompassing 240 patients treated with embolization (using coils or Amplatzer Vascular Plugs (AVP)) were analyzed. Key metrics assessed included patient demographics, embolization techniques, embolic agents, technical success, radiologic findings pre- and post-embolization, and complication rates.
RESULTS: Among the 240 patients studied, 177 (73.8%) were reported by gender, with a majority being male (127/177, 71.7%). Doppler ultrasonography (DUS) emerged as the primary initial screening tool in 80% of studies. The hepatic arterial resistive index (RI) was a critical parameter, with mean values significantly decreasing from 0.84 pre-embolization to 0.70 post-embolization (p < 0.001). All cases confirmed technical success via digital subtraction angiography, revealing delayed hepatic arterial filling without stenosis or thrombosis. Coils were the predominant embolic agent, used in 80.8% of patients, followed by AVP in 16.3%. The overall mortality rate was 4.58%, with 29 major and 3 minor complications noted. Notably, proximal placement of coils in the splenic artery was associated with lower mortality rates compared to distal placement and showed comparable complication rates to AVPs.
CONCLUSIONS: DUS is a reliable screening modality for NOHAH, with post-SAE assessments showing significant improvements. The choice and location of embolization significantly impact patient outcomes, with proximal placement of coils emerging as a preferable strategy due to lower mortality rates and comparable complication profiles to alternative methods.