D. A. Marsh1, M. Day1, J. Wu1, A. Maleson1, J. Vosswinkel1, E. Huang1, R. S. Jawa1 1Stony Brook University Medical Center,Stony Brook, NY, USA
Introduction: The management of blunt splenic injury has changed in the last 20 years. Historically, blunt splenic injury patients routinely underwent splenectomy or splenorrhaphy. Currently, in the absence of absolute indications for laparotomy, splenic artery embolization (SAE) is pursued at many trauma centers. We sought to evaluate the demographics and outcomes of blunt splenic injury patients managed by SAE.
Methods: With IRB approval, we retrospectively reviewed the trauma registry at an ACS level I suburban trauma center for adult (age≥ 18 years) blunt trauma admissions between 1/2008 and 9/2018 who sustained a splenic injury. Emergency department deaths were excluded. Patients (n=3) who had splenic angiography without embolization were excluded from further analysis. Chart review was conducted on SAE patients.
Results: There were 426 blunt splenic injury patients meeting study criteria. 45 (10.6%) patients, with a median age of 50 years (IQR 30-67), were managed with SAE. Further demographic information is provided in the table.
42 patients with successful SAE had a median spleen AIS of 3. Locations of these SAEs were 52.4% proximal splenic artery, 4.8% distal splenic artery, 7.1% main splenic artery not further specified, and 28.6% splenic artery branches; 6.7% were not specified. Regarding the embolization material used: 71.4% coils, 9.5% gelfoam, 9.5% Amplatzer plugs, and 9.5% were a combination of coils and gelfoam. CT findings prior to embolization were contrast blush (64.3%), pseudoaneurysm (9.5%), both contrast blush and PSA (4.8%). An additional 21.4% were done empirically (i.e. injury grade/surgeon preference).
SAE failed in 3 patients with a median spleen AIS of 4, leading to subsequent splenectomy. Two had proximal SAE; the third embolization failed and the procedure was aborted. One proximal SAE was done with coils, the other with both coils and gelfoam. They underwent splenectomy on a median of HD#6.
Of the 42 SAE patients who did not undergo subsequent splenectomy, one patient expired from her advanced underlying disease on HD#11. Three patients were readmitted (pain at groin catheterization site, abdominal pain, hemothorax with splenic fluid collection), 3 had splenic abnormalities noted on subsequent imaging (1 infarct, 1 new pseudoaneurysm, 1 splenic pseudocyst), and one patient had proximal splenic artery perforation during procedure (bleeding ceased spontaneously during the procedure). None of these 42 patients developed abscesses.
Conclusion: SAE was successful in 93.3% of patients in avoiding subsequent splenectomy. Given the data size, it is difficult to delineate the optimal location for embolization or type of material. However, we currently favor proximal embolization with coils.
