Angioembolization significantly improves vascular injuries in blunt splenic trauma

Abstract

Purpose

Non-operative management (NOM) of blunt splenic injury (BSI) uses angioembolization (AE) or observation (OBS). AE improves the success of NOM. However, how AE improves BSI is unknown. We hypothesized AE would decrease rate of pseudoaneurysm (PSA) presence, PSA size, PSA number, and rate of active extravasation.

Methods

We performed a retrospective review of computerized tomography (CT)-diagnosed BSI over a 2-year period. Patients undergoing NOM with an initial and repeat CT were included. Patients were excluded if they underwent primary splenectomy after BSI diagnosis or did not have repeat CT imaging.

Results

One hundred and fifteen patients with BSI had repeat CT imaging; 55/115 (47.8%) had AE; and 60/115 (52.2%) had OBS. On the initial CT, AE patients had more frequent PSA presence (52.7% vs. 6.7%, p < 0.001), higher median number of PSA (1.0 vs. 0, p < 0.001), higher median PSA size (1.15 mm vs. 0 mm, p < 0.001), and more frequent rates of active extravasation (10.9% vs. 0%, p = 0.01) compared with OBS patients. On repeat CT compared to the initial CT, AE patients had significant decrease in rate of PSA presence (21.8% vs. 52.7%, p < 0.001), median PSA size (0 mm vs. 1.15 mm, p < 0.001), median PSA number (p < 0.001), and rate of active extravasation (0% vs. 10.9%, p = 0.03). On repeat CT compared to the initial CT, OBS patients had an increase in rate of PSA presence (18.3% vs. 6.7%, p = 0.04).

Conclusions

AE significantly decreases PSA presence, number, and size as well as rates of active extravasation. AE should be standard practice in vascular injuries undergoing NOM to maximize splenic salvage.

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Correspondence to Margaret H. Lauerman.

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Conflict of interest

Margaret Lauerman, Kathirkamanathan Shanmuganathan, Nana Simpson, Deborah Stein, and Thomas Scalea have no conflicts of interest to report. Megan Brenner is on the Clinical Advisory Board of Prytime Medical Inc.

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Lauerman, M.H., Brenner, M., Simpson, N. et al. Angioembolization significantly improves vascular injuries in blunt splenic trauma. Eur J Trauma Emerg Surg 47, 99–103 (2021). https://doi.org/10.1007/s00068-019-01151-z

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Keywords

  • Splenic injury
  • Pseudoaneurysm
  • Angioembolization