Proximal splenic embolisation versus distal splenic embolisation for management of focal distal arterial injuries of the spleen

Abstract

Introduction: To compare the outcomes of proximal (pSAE) versus distal (dSAE) splenic artery embolisation for management of focal distal arterial splenic injuries secondary to blunt splenic trauma. Method: Ethical approval was granted by the hospital research and ethics committee, Project 389/19. All patients who underwent splenic artery embolisation secondary to blunt abdominal trauma from 1 January 2009 to 1 January 2019 were reviewed. Patients with a tandem embolisation (both proximal and distal embolisations) or those with no acute vascular injury on angiography were excluded. Patient demographics, injury type/ AAST grade (2018 classification), technique of embolisation and outcomes were collected. Complications and splenectomy rates up to 30 days were recorded. Results: 136 out of 232 patients had an embolisation performed for a distal vascular injury including active arterial bleeding, pseudoaneurysm or arteriovenous fistula. Mean age was 41 (range 16-84). Mean AAST grade was 4 (range 3-5). Mean Injury Severity Score was 22. pSAE was performed in 79.4% (n = 108) and dSAE in 20.6% (n = 28). Major complications occurred in 12 patients (pSAE n = 12, 11.1%; dSAE n = 0, P > 0.05); 6 pSAE required splenectomy (n = 6, 5.6%). There was no significant difference in outcomes between the two groups or when based on AAST grading. Conclusion: No significant difference was observed between proximal and distal embolisation techniques for blunt trauma patients with a distal vascular injury in terms of technical and clinical success.

Blunt splenic injury, Emergency Department to discharge: A Western Trauma Association critical decisions algorithm

“…Proximal embolization reduces perfusion pressure to the injury, allowing for physiologic hemostasis. However, some studies have reported a higher complication rate with proximal embolization, including rebleeding and need for splenectomy 21,23,24 …”

“…However, some studies have reported a higher complication rate with proximal embolization, including rebleeding and need for splenectomy. 21,23,24 Agents used in splenic artery embolization include Gelfoam® (Pfizer Inc., Manhattan, New York) and coils.…”

“…Main (proximal) splenic artery embolization versus distal (selective) branch embolization is controversial, with reported complication rates of 8% to 62% associated with either technique. [20][21][22] Distal embolization tends to be used for singular lesions for which blood flow can be eliminated, while embolization of the main splenic artery is used for multifocal or large parenchymal injuries. In less stable patients, proximal embolization may be preferred because the time required is often shorter.…”

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

“…However, there was a statistically significant difference in fluoroscopy time between the proximal (10.1 ± 4.2 min) and distal groups (17.8 ± 8.7 min). Other studies [ 96 , 97 ] showed equivalent results between the two techniques regarding technical and clinical success. Proximal SAE was associated with fewer and smaller infarcts than distal SAE in a series of CT scans of the embolized spleen in another study [ 98 ].…”