Residual Splenic Volume after Main Splenic Artery Embolization is Independent of the Underlying Disease

Abstract

Purpose: To assess the safety and efficacy of main splenic artery embolization. To assess the potential difference post-embolization of the residual splenic volume in patients embolized for trauma versus those embolized for (pseudo)aneurysms. Materials and Methods: A retrospective analysis was performed on a cohort of 65 patients (36 males) who underwent pre- and post-embolization computed tomography. Patients’ demographics, pre- and post-interventional medical and radiological data were gathered. Splenic volume calculations were semi-automatically performed via a workstation. Patients with splenic aneurysms or pseudoaneurysms of the main splenic artery (group 1) were compared to those with splenic rupture (group 2) using Wilcoxon rank tests. Results: The main indications for splenic artery embolization were splenic rupture (n = 22; 34%) and splenic pseudoaneurysm (n = 19; 29%). The technical success rate was n = 63; 97%. The procedure-related complication rate was n = 7; 11%, including abscess formation (n = 5; 8%), re-bleeding (n = 1; 1.5 %) and pseudoaneurysm re-opening (n = 1; 1.5%). The overall 30-day mortality was n = 7; 11%. Median follow-up for groups 1 and 2 was 1163 days (61–3946 days) and 702 days (43–2095 days) respectively. When processable (n = 23), the splenic volume in group 1 (n = 7) was 311 cm 3 and 257 cm 3 (p = 0.1591) before and after embolization respectively, and in group 2 (n = 16) it was 261 cm 3 and 215 cm 3 (p = 0.4688), respectively. Conclusions: Main splenic artery embolization is efficacious, with low procedure-related complication and 30-day mortality rates. No significant differences in residual post-embolization splenic volume were found between patients treated for splenic rupture versus those treated for splenic arterial (pseudo)aneurysm.

A retrospective multi‐centre study of splenic volumes measured by CT following splenic artery angioembolisation for high‐grade blunt splenic injuries in adults

“…11 Both these cohorts predominantly underwent proximal embolisation. 4,11 This study differed with 73.3% of patients undergoing only distal embolisation. A further difference was that the clinical pathway utilised in this study allows for observation of high-grade splenic injuries, 10 whereas other published studies have relied on protocols based on routine angioembolisation.…”

“…Another followed a cohort of 17 patients out to 7.7 years and showed preserved spleen function as measured by IgM memory B Cells, in spite of an overall reduction in splenic volume 11 . Both these cohorts predominantly underwent proximal embolisation 4,11 . This study differed with 73.3% of patients undergoing only distal embolisation.…”

“…One study had no significant change in splenic volume with a mean follow up of 1.9 years for their trauma cohort. 4 Another followed a cohort of 17 patients out to 7.7 years and showed preserved spleen function as measured by IgM memory B Cells, in spite of an overall reduction in splenic volume. 11 Both these cohorts predominantly underwent proximal embolisation.…”

“…A previous small cohort study demonstrated a decreased splenic volume with distal embolisation and increased volume with proximal embolisation but has not commented on further associations with American Association of the Surgery of Trauma (AAST) grading and splenic function 3 . More recent data have shown no significant change in spleen volume over a median follow up of 1.9 years for the trauma cohort 4 . Longer term studies, out to 8 years, with predominantly proximal embolisation, have demonstrated preservation of immune function post splenic artery embolisation for trauma, with a corresponding decrease in volume, as measured by ultrasound 5 …”

“…3 More recent data have shown no significant change in spleen volume over a median follow up of 1.9 years for the trauma cohort. 4 Longer term studies, out to 8 years, with predominantly proximal embolisation, have demonstrated preservation of immune function post splenic artery embolisation for trauma, with a corresponding decrease in volume, as measured by ultrasound. 5 Post embolisation volume may be of use for ongoing surveillance as while volume correlates poorly with splenic function, total splenectomy results in absolute loss of splenic function.…”