Splenic artery embolization in the treatment of blunt splenic injury: single level 1 trauma center experience

Abstract

Purpose: To describe the experience of a single level 1 trauma center in the management of blunt splenic injuries (BSI).

Methods: This is a retrospective study with Institutional Review Board approval. The medical records of 450 patients with BSI treated between January 2016 and December 2022 were reviewed. Seventy-two patients were treated with splenic artery embolization (SAE), met the study criteria, and were eligible for data analysis. Spleen injuries were graded in accordance with the American Association for the Surgery of Trauma Organ Injury Scale. Univariate data analysis was performed, with P < 0.05 considered statistically significant.

Results: The splenic salvage rate was 90.3% (n = 65/72). Baseline demographics were similar between the groups (P > 0.05). Distal embolization with Gelfoam^® had similar rates of splenic salvage to proximal embolization with coils (90% vs. 94.1%, P > 0.05). There was no significant difference in the rate of splenic infarction between distal embolization with Gelfoam^® (20%, 4/20) and proximal embolization with coils (17.6%, 3/17) (P > 0.05). There was no significant difference in procedure length (68 vs. 75.8 min) or splenic salvage rate (88.5% vs. 92.1%) between proximal and distal embolization (P > 0.05). There was no significant difference in procedure length (69.1 vs. 73.6 min) or splenic salvage rate (93.1% vs. 86.4%) between Gelfoam^® and coil embolization (P > 0.05). Combined proximal and distal embolization was associated with a higher rate of splenic abscess formation (25%, 2/8) when compared with proximal (0%, 0/26) or distal (0%, 0/38) embolization alone (P = 0.0003). The rate of asymptomatic and symptomatic splenic infarction was significantly higher in patients embolized at combined proximal and distal locations (P = 0.04, P = 0.01).

Conclusion: The endovascular management of BSI is safe and effective. The overall splenic salvage rate was 90.3%. Distal embolization with Gelfoam^® was not associated with higher rates of splenic infarction when compared with proximal embolization with coils. Combined proximal and distal embolization was associated with a higher incidence of splenic infarction and splenic abscess formation.

Clinical significance: Distal splenic embolization with Gelfoam^® is safe and may be beneficial in the setting of blunt splenic trauma.

Keywords: Coil; Gelfoam®; combined; distal; embolization; proximal; spleen; trauma.

Figure 1

Flowchart. AAST-OIS, American Association for the Surgery of Trauma Organ Injury Scale.

Figure 2

Celiac digital subtraction angiography showing the main splenic artery arising from the celiac trunk. The dorsal pancreatic artery (arrow) arises from the main splenic artery.

Figure 3

Proximal splenic artery embolization with coils in a 49-year-old woman following a motor vehicle collision. (a) Contrast-enhanced computed tomography showing a grade III splenic laceration and significant hemoperitoneum. (b) Pre-embolization celiac digital subtraction angiography (DSA) with no contrast extravasation or pseudoaneurysm. (c) Post embolization DSA displaying decreased but preserved perfusion to the spleen. Multiple detachable AZUR CX coils (Terumo Interventional Systems, Tokyo, Japan) and pushable Tornado coils (Cook Medical, Bloomington, IN, USA) can be seen in the main splenic artery, distal to the dorsal pancreatic artery.

Figure 4

Distal splenic artery embolization with Gelfoam® in a 75-year-old woman following a motor vehicle collision. (a) Contrast-enhanced computed tomography showing multiple splenic lacerations with a perisplenic hemoperitoneum and active contrast extravasation. (b, c) Pre-embolization celiac digital subtraction angiography (DSA) showing multiple splenic arterial blushes without active contrast extravasation. (d) Post-embolization DSA displaying Gelfoam® embolization of splenic artery branches distal to all collateral pathways.