Nonoperative management of blunt splenic trauma: Outcomes of Gelfoam embolization of the splenic artery

Abstract

Context:Nonoperative management (NOM) is the standard of care in hemodynamically stable trauma patients with blunt splenic injury. Gelfoam splenic artery embolization (SAE) is a treatment option used in trauma patients.Aims:The primary aim of this study was to retrospectively examine the use and outcomes of Gelfoam SAE in adult patients with blunt splenic injury.Settings and Design:One hundred and thirty-two adult patients with blunt splenic injury admitted to a Level 1 trauma center between January 2014 and December 2015 were included in the study. Patients treated with Gelfoam SAE, NOM, and splenectomies were reviewed. Descriptive statistics including patient age, Glasgow Coma Scale, Injury Severity Score (ISS), hospital days, Intensive Care Unit (ICU) days, splenic grade, and amount of blood products administered were recorded. Complications, defined as any additional factors that contributed to the patient's overall length of hospital stay, were compared between the three groups. Technical aspects of Gelfoam SAE and associated complications were reviewed.Subjects and Methods:Gelfoam SAE was performed in 25 (18.9%) of the 132 patients. Gelfoam SAE patients had fewer ICU days compared with those patients who had a splenectomy or NOM. There was no statistical difference in complications between patients who underwent Gelfoam SAE and those who did not. Patients who underwent Gelfoam SAE tended to have fewer complications including deep venous thrombosis's, PE, and infections and yielded no complications in 64% of the Gelfoam group.Statistical Analysis:Statistical analysis included descriptives, ANOVA, and nonparametric tests as appropriate.Conclusion:Gelfoam SAE can be used for blunt splenic injury for intermediate ISS and splenic grade as it reduced hospital and ICU days.

Let us settle the controversy—gelfoam is a safe intravascular embolic agent

“…In the setting of splenic artery trauma, Freeman et al assessed the safety of gelfoam embolization, and demonstrated a low rate of adverse events, fewer complications, and a shorter hospital length of stay than with surgical or conservative treatment approaches to splenic injury. 11 There have also been several studies from Australia which have shown the safe and cost-effective use of gelfoam. 12 However, as with all treatments and medications, adverse events occur, albeit uncommonly.…”