Splenic embolization revisited: a multicenter review.
BACKGROUND
Splenic embolization can increase nonoperative salvage. However, complications are not clearly defined. A retrospective multicenter review was performed to delineate the risks and benefits of splenic embolization.


METHODS
A retrospective chart review of all patients undergoing splenic embolization from 1997 to 2002 at four separate Level I trauma centers was performed. Reviewed results included patient demographics, admission and follow-up computed tomographic scan results, angiographic technique, and patient outcomes including splenic salvage rate and procedural complications.


RESULTS
A total of 140 patients were reviewed. The majority were young male patients involved in motor vehicle crashes. These patients had high abdominal computed tomographic grades of splenic injury and moderate Injury Severity Scores. The splenic salvage rate was 87%, which decreased with increasing injury grade. However, over 80% of splenic injury grades 4 and 5 were successfully managed nonoperatively. Significant hemoperitoneum did not affect success, but the presence of arteriovenous fistula was associated with a high failure rate, even with embolization. Salvage rates were similar between main coil and subselective embolization groups. Patients over 55 years of age did no worse than younger patients. Major complications included bleeding in 16 patients; 6 splenic abscesses, with 5 patients requiring splenectomy; and 1 episode of arterial injury requiring operative repair.


CONCLUSIONS
Splenic embolization remains a valuable technique in splenic salvage, especially in higher grade injuries. Complications are common but do not seem to affect outcome.
Haan
James M
JM
Department of Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201-1595, USA. jhaan@umm.edu
Biffl
Walter
W
Knudson
M Margaret
MM
Davis
Kimberly A
KA
Oka
Tomomi
T
Majercik
Sarah
S
Dicker
Rochelle
R
Marder
Shelley
S
Scalea
Thomas M
TM
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000628:therapy; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011859:Radiography; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000706:statistics & numerical data; D013154:Spleen / Q000098:blood supply*; D013156:Splenectomy / Q000706:statistics & numerical data; D013161:Splenic Rupture / Q000000981:diagnostic imaging / Q000628:therapy*; D014193:Trauma Centers / Q000706:statistics & numerical data; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*