SPLEnic salvage and complications after splenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study

Abstract

Background As an adjunct to non-operative management, splenic artery embolization (SAE) has been increasingly utilized throughout the world and is now the standard of care for hemodynamically stable patients. This study aimed to retrospectively assess the rate of splenic salvage and complications after SAE for blunt trauma at a level 1 trauma center using the 2018 update to the AAST criteria, and further sub-stratify the role of angiography in AAST grade III injuries with significant hemoperitoneum. All patients between 1 January 2009 and 1 January 2019 who underwent blunt trauma and proceeded to embolization were included. Data was collected concerning initial injury grade, location of embolization, type of embolic material used, complications, and need for subsequent splenectomy. Technical success was defined as successful angiographic occlusion of the target artery at the conclusion of embolization. Clinical success was defined as splenic salvage at discharge. Vascular lesions were characterized including those with active bleeding, pseudoaneurysm, and arterio-venous fistula. Results Two hundred thirty-two patients were included in the study. Treatments were performed at a median of 0 days (range 0–28 days) and the median AAST grade was IV (range III-V). Technical success was achieved in all patients. There were 13 complications (5.6%) consisting of re-bleed (9, 3.9%), infarction (3, 1.3%), and access site haematoma (1, 0.43%). Clinical success was achieved in 97% of patients with 7 patients requiring splenectomy after SAE (3.0%) at a median time of 4 days (range 0–17 days). Angiography in patients with grade III injuries identified 18 occult vascular injuries not identified at initial CT (p < 0.0001). Conclusions The SPLEEN-IN study shows that treatment of intermediate-high grade blunt force traumatic splenic injuries using SAE resulted in a low rate of complication and splenic salvage in 97% of patients, providing a safe and effective treatment in stable patients. In addition, angiography of grade III injuries identified occult vascular lesions and may warrant treatment of select patients in this cohort. Level of evidence Level 3.

Retrospective Evaluation of Splenic Artery Embolization Outcomes in the Management of Blunt Splenic Trauma: A Single Centre Experience at a Large Level 1 Trauma Centre

“…This study affirms that there is a high rate (97.8%) of splenic salvage in patients who have SAE and is in keeping with rates previously described in the literature. 7,[14][15][16] Patients in this series who ended up with a splenectomy did so while being treated for other injuries that required a laparotomy. Splenic bleeding described as slow in the OR notes was incidentally identified during the laparotomy and it is difficult to know for certain if this bleeding would have been clinically significant in the absence of other injuries.…”

Pros and cons of splenic artery embolization after mechanical splenic injury - comparison of methods.

“…Cobra C2) lub odwrotnie zakrzywionego (np Simmons). Po wejściu do tętnicy śledzionowej możliwe jest dokonanie embolizacji całe tętnicy (embolizacja proksymalna) lub jej poszczególnych gałęzi (embolizacja dystalna) do której zazwyczaj potrzebne jest użycie mikrocewnika [9,12]. Najpopularniejszymi materiałem zatorowym jest spirala embolizacyjna ze względu na najmniejsze powikłania [11].…”

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

“…A retrospective review was conducted of all patients with a splenic injury following blunt splenic trauma in a level 1 trauma centre from 1 January 2009 to 1 January 2019, and this information was collected for subanalysis as part of a larger study. 18 Patients were identified on the Radiology Information System (RIS) and Picture and Communications System (PACS). Patients were included if they underwent angiography and embolisation in the setting of blunt abdominal trauma for a focal vascular injury demonstrated on angiography.…”