Blunt splenic injury: usefulness of transcatheter arterial embolization in patients with a transient response to fluid resuscitation

Abstract

Purpose: To evaluate the use of transcatheter arterial embolization (TAE) in hemodynamically unstable patients with blunt splenic injury in whom there is a transient response to initial fluid resuscitation.

Materials and methods: Human subject committee approval and informed consent were obtained. Angiography was performed in patients with contrast material extravasation and/or splenic injury of grade III or higher (American Association for the Surgery of Trauma criteria) at computed tomography (CT). TAE was performed when angiograms showed disruption of terminal splenic branches or arterial extravasation. Among 104 patients with splenic injury, the 15 patients (10 male, five female; mean age, 36.2 years) with a transient response to fluid resuscitation were the subjects of this study. A post hoc analysis was performed for CT grades, angiographic findings, associated injuries, and hemodynamic status in the subjects.

Results: Among 15 patients with a transient response, two had grade III, 11 had grade IV, and two had grade V injuries at CT. Six patients had associated injuries that required TAE. TAE of the spleen and associated injuries was successfully performed in all patients. The mean systolic blood pressure and shock index at the start of TAE were 84.2 mm Hg +/- 9.2 (standard deviation) and 1.46 +/- 0.30, respectively, and those at the completion of TAE were 132.1 mm Hg +/- 18.7 and 0.77 +/- 0.21, respectively (P < .001). The fluid infusion rate within 24 hours after the completion of TAE (132.1 mL/h +/- 71.1) was lower than that from the completion of the initial fluid resuscitation until the completion of TAE (1230.6 mL/h +/- 264.8) (P < .001).

Conclusion: TAE for blunt splenic injury can be performed successfully even in hemodynamically unstable patients with a transient response to initial fluid resuscitation.