Splenic artery angioembolization for high-grade splenic injury: Are we wasting money?

Senekjian, Lara; Cuschieri, Joseph

doi:10.1016/j.amjsurg.2020.06.011

Cited by 6 publications

(4 citation statements)

References 37 publications

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“…A retrospective NTDB review by Dolejs et al 19 of greater than 53,000 patients with splenic injury over a 7-year period showed that while rates of AE have increased, there was no significant change in overall rate of splenectomy. Another report by Senekjian et al 20 documented the cost of AE and its impact on the management of patients with splenic trauma. These investigators found that NOM without AE was more cost effective in >85% of patients with AAST Grade V splenic injuries, and that NOM without AE provided more quality adjusted life years to patients with splenic injury.…”

Section: Discussionmentioning

confidence: 99%

A pseudo-dilemma: Are we over-diagnosing and over-treating traumatic splenic intraparenchymal pseudoaneurysms?

Radding,

Harfouche,

Dhillon

et al. 2023

J Trauma Acute Care Surg

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Introduction Splenic embolization for traumatic vascular abnormalities in stable patients is a common practice. We hypothesize that modern contrast-enhanced CT over diagnoses post-traumatic splenic vascular lesions such as intraparenchymal pseudoaneurysms (PSA) that may not require embolization. Methods We reviewed the experience at our high-volume center with endovascular management of blunt splenic injuries from Jan 2016-Dec 2021. Multidisciplinary review was used to compared initial CT findings to subsequent angiography, analyzing management and outcomes of identified vascular lesions. Results Of 853 splenic injuries managed overall during the study period, 255 (29.9%) underwent angiography of the spleen at any point during hospitalization. Vascular lesions were identified on 58% of initial CTs; extravasation (12.2%) and PSA (51.0%). Angiography was performed a mean of 22 hours after admission, with 38% done within 6 hours. Embolization was performed for 90.5% (231) of patients. Among the 130 patients with PSA on initial CT, 36 (27.7%) had no visible lesion on subsequent angiogram. From the 125 individuals who did not have a PSA identified on their initial CT, 67 (54%) had a PSA seen on subsequent angiography. On post-embolization CT at 48-72 hours, persistently perfused splenic PSAs were seen in 41.0% (48/117) of those with and 22.2% (2/9) without embolization. Only one of 24 (4.1%) patients with PSA on angiography observed without embolization required delayed splenectomy, whereas 6.9% (16/231) in the embolized group had splenectomy at a mean of 5.5 + 4 days after admission. Conclusion There is a high rate of discordance between CT and angiographic identification of splenic PSAs. Even when identified at angiogram and embolized, close to half will remain perfused on follow-up imaging. These findings question the use of routine angioembolization for all splenic PSAs. Level of Evidence IV Study Type Therapeutic/care management

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Section: Discussionmentioning

confidence: 99%

A pseudo-dilemma: Are we over-diagnosing and over-treating traumatic splenic intraparenchymal pseudoaneurysms?

Radding,

Harfouche,

Dhillon

et al. 2023

J Trauma Acute Care Surg

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show abstract

“…Patients, thus, have to be matched before NOM could be included in the cost-effectiveness analysis. A recent study (24) on the cost effectiveness of SAE versus NOM in the United States showed that SAE was more expensive and resulted in less QALYs. Future studies have to explore how these results translate to other countries.…”

Section: Discussionmentioning

confidence: 99%

Cost Effectiveness of Splenic Artery Embolization versus Splenectomy after Trauma in the Netherlands

Kanters

Raaijmakers

Lohle

et al. 2022

Journal of Vascular and Interventional Radiology

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“…2 13-17 Other studies have suggested that SAE may be cost-effective when compared with patients requiring additional intervention after NOM and proceeding to splenectomy. [18][19][20] Previously, groups have examined the causes of failure of NOM or SAE, thromboelastography (TEG)-directed resuscitation to improve outcomes, and prospective and retrospective evaluation of SAE and the need for additional intervention. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] However, the prediction of failure of SAE patients remains a challenge.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

Angioembolization for splenic injuries: does it help? Retrospective evaluation of grade III–V splenic injuries at two level I trauma centers

Ahmad,

Lee,

Tennakoon

et al. 2024

Trauma Surg Acute Care Open

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BackgroundSplenic angioembolization (SAE) has increased in utilization for blunt splenic injuries. We hypothesized lower SAE usage would not correlate with higher rates of additional intervention or mortality when choosing initial non-operative management (NOM) or surgery.Study designTrauma registries from two level I trauma centers from 2010 to 2020 were used to identify patients aged >18 years with grade III–V blunt splenic injuries. Results were compared with the National Trauma Data Bank (NTDB) for 2018 for level I and II centers. Additional intervention or failure was defined as any subsequent SAE or surgery. Mortality was defined as death during admission.ResultsThere were 266 vs 5943 patients who met inclusion/exclusion criteria at Stanford/Santa Clara Valley Medical Center (SCVMC) versus the NTDB. Initial intervention differed significantly between cohorts with the use of SAE (6% vs 17%, p=0.000). Failure differed significantly between cohorts (1.5% vs 6.5%, p=0.005). On multivariate analysis, failure in NOM was significantly associated with NTDB cohort status, age 65+ years, more than one comorbidity, mechanism of injury, grade V spleen injury, and Injury Severity Score (ISS) 25+. On multivariate analysis, failure in SAE was significantly associated with Shock Index >0.9 and 10+ units blood in 24 hours. On multivariate analysis, a higher risk of mortality was significantly associated with NTDB cohort status, age 65+ years, no private insurance, more than one comorbidity, mechanism of injury, ISS 25+, 10+ units blood in 24 hours, NOM, more than one hospital complications, anticoagulant use, other Abbreviated Injury Scale ≥3 abdominal injuries.ConclusionsCompared with national data, our cohort had less SAE, lower rates of additional intervention, and had lower risk-adjusted mortality. Shock Index >0.9, grade V splenic injuries, and increased transfusion requirements in the first 24 hours may signal a need for surgical intervention rather than SAE or NOM and may reduce mortality in appropriately selected patients.Level of evidenceLevel II/III.

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Splenic artery angioembolization for high-grade splenic injury: Are we wasting money?

Cited by 6 publications

References 37 publications

A pseudo-dilemma: Are we over-diagnosing and over-treating traumatic splenic intraparenchymal pseudoaneurysms?

A pseudo-dilemma: Are we over-diagnosing and over-treating traumatic splenic intraparenchymal pseudoaneurysms?

Cost Effectiveness of Splenic Artery Embolization versus Splenectomy after Trauma in the Netherlands

Angioembolization for splenic injuries: does it help? Retrospective evaluation of grade III–V splenic injuries at two level I trauma centers

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