Abstract
Purpose
This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma.
Methods
A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes.
Results
Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16–80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies.
Conclusions
Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.
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References
Godley CD, Warren RL, Sheridan RL, McCabe CJ (1996) Nonoperative management of blunt splenic injury in adults: age over 55 years as a powerful indicator for failure. J Am Coll Surg 183(2):133–139
Peitzman AB, Harbrecht BG, Rivera L, Heil B (2005) Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg 201(2):179–187
Cocanour CS, Moore FA, Ware DN, Marvin RG, Clark JM, Duke JH (1998) Delayed complications of nonoperative management of blunt adult splenic trauma. Arch Surg 133(6):619–624 discussion 624–625
Bessoud B, Denys A, Calmes JM et al (2006) Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization? AJR Am J Roentgenol 186(3):779–785
Harbrecht BG, Ko SH, Watson GA, Forsythe RM, Rosengart MR, Peitzman AB (2007) Angiography for blunt splenic trauma does not improve the success rate of nonoperative management. J Trauma 63(1):44–49
Smith HE, Biffl WL, Majercik SD, Jednacz J, Lambiase R, Cioffi WG (2006) Splenic artery embolization: Have we gone too far? J Trauma 61(3):541–544 discussion 545–546
Dent D, Alsabrook G, Erickson BA et al (2004) Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization. J Trauma 56(5):1063–1067
McIntyre LK, Schiff M, Jurkovich GJ (2005) Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg 140(6):563–568 discussion 568–569
Velmahos GC, Chan LS, Kamel E et al (2000) Nonoperative management of splenic injuries: have we gone too far? Arch Surg 135(6):674–679 discussion 679–681
Gauer JM, Gerber-Paulet S, Seiler C, Schweizer WP (2008) Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy. World J Surg 32(12):2730–2735
Wiseman J, Brown CV, Weng J, Salim A, Rhee P, Demetriades D (2006) Splenectomy for trauma increases the rate of early postoperative infections. Am Surg 72(10):947–950
Tinkoff G, Esposito TJ, Reed J et al (2008) American Association for the Surgery of Trauma organ injury scale I: spleen, liver, and kidney. Validation based on the national trauma data bank. J Am Coll Surg 207(5):646–655
Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness: a practical scale. Lancet 304(7872):81–84
Wahl WL, Ahrns KS, Chen S, Hemmila MR, Rowe SA, Arbabi S (2004) Blunt splenic injury: operation versus angiographic embolization. Surgery 136(4):891–899
Cooney R, Ku J, Cherry R et al (2005) Limitations of splenic angioembolization in treating blunt splenic injury. J Trauma 59(4):926–932 discussion 932
Haan J, Scott J, Boyd-Kranis RL, Ho S, Kramer M, Scalea TM (2001) Admission angiography for blunt splenic injury: advantages and pitfalls. J Trauma 51(6):1161–1165
Ekeh AP, McCarthy MC, Woods RJ, Haley E (2005) Complications arising from splenic embolization after blunt splenic trauma. Am J Surg 189(3):335–339
Haan JM, Biffl W, Knudson MM et al (2004) Splenic embolization revisited: a multicenter review. J Trauma 56(3):542–547
Gaarder C, Dormagen JB, Eken T et al (2006) Nonoperative management of splenic injuries: improved results with angioembolization. J Trauma 61(1):192–198
Killeen KL, Shanmuganathan K, Boyd-Kranis R, Scalea TM, Mirvis SE (2001) CT findings after embolization for blunt splenic trauma. J Vasc Intervent Radiol 12(2):209–214
Young J (2010) University of Virginia Health System Level I Trauma Center Trauma Handbook (online). Available at: https://www.healthsystem.virginia.edu/intranet/surgery-trauma/clinical/TraumaCenterPocketManual-ON-LINE-and-PRINT-2_2011.pdf. Accessed 23 April 2011
Conflict of Interest
Niloy Dasgupta, Bulent Arslan, Ulku C. Turba, Saher Sabri: None. Alan H. Matsumoto: Scientific Advisory Board: Boston Scientific, Honoraria: Bard, Grant: Cook. John F. Angle: Grant: Terumo Corp, Honoraria: Cook.
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Dasgupta, N., Matsumoto, A.H., Arslan, B. et al. Embolization Therapy for Traumatic Splenic Lacerations. Cardiovasc Intervent Radiol 35, 795–806 (2012). https://doi.org/10.1007/s00270-011-0186-y
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DOI: https://doi.org/10.1007/s00270-011-0186-y