Admission angiography for blunt splenic injury: advantages and pitfalls.
BACKGROUND
To analyze the use of admission angiography as a nonoperative adjunct for management of blunt splenic injury.


METHODS
Retrospective chart review of all blunt splenic injuries to a Level I trauma center from March 1997 through July 1999.


RESULTS
One hundred twenty-six patients underwent angiography for splenic injury. Eighty-six patients (68%) had a negative angiogram and were treated expectantly. Of these, seven patients (8%) required laparotomy, with a splenic salvage rate of 92%. Embolization was performed on 40 patients (32%) for evidence of vascular injury. Of these, three patients (8%) required laparotomy, for a total salvage of 92%. Repeat angiography was performed for suspicion of bleeding in 12 patients (10%), with 50% requiring embolization. Outcome based on CT grade demonstrated an average grade of 2.9, with a salvage rate of greater than 70% for grade IV and V injuries.


CONCLUSIONS
Vascular injury increases with splenic injury grade. Embolization improves nonoperative salvage rates to 92%, even with high-grade injuries. Ten percent of patients require additional therapy including "second-look" angiography. A significant portion of patients with negative screening angiograms (10%) required either embolization or laparotomy to control delayed hemorrhage.
Haan
J
J
Department of Surgery, University of Maryland School of Medicine, Baltimore, USA. jhaan@trauma.ummc.umaryland.edu
Scott
J
J
Boyd-Kranis
R L
RL
Ho
S
S
Kramer
M
M
Scalea
T M
TM
D000328:Adult; D000792:Angiography / Q000592:standards*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008499:Medical Records; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*