title: Use of splenic artery embolization as an adjunct to nonsurgical management of blunt splenic injury.
abstract: BACKGROUND
  Splenic artery embolization (SAE) has been used as an adjunct to the nonsurgical treatment of blunt splenic injuries since 1981. It is imperative to define the role of SAE in the management of splenic trauma and to establish a guideline for its use.
  
  
  METHODS
  In this study, 39 consecutive patients with blunt splenic ruptures were evaluated. All the patients were treated according to the authors' protocol, which included SAE as an adjunct. Angiographic study was performed for patients with any of the following presentations: recurrent hypotension despite fluid resuscitation, significant hemoperitoneum or extravasation of contrast media on computed tomography, grade 4 or 5 splenic injury, or progressive need for blood transfusion. Laparotomy was reserved for patients with unstable hemodynamics or failure of SAE.
  
  
  RESULTS
  Four patients were excluded from the study, and 6 of the 35 remaining patients (male-to-female ratio, 22:13) received SAE. One of the six SAE patients underwent operation because of persistent hemorrhage after SAE. Nonoperative treatment was successful for 31 patients. Splenic artery embolization increased the success rate for nonsurgical management from 74% (26 of 35 patients) to 89% (31 of 35 patients).
  
  
  CONCLUSIONS
  Judicious use of SAE for patients with blunt splenic injury avoids unnecessary surgery and expands the number of patients who can retain their spleen.
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. poping@ms9.hinet.net
authors.forename: Po Ping
authors.initials: PP
authors.lastname: Liu
authors.forename: Wei Che
authors.initials: WC
authors.lastname: Lee
authors.forename: Yu Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Pei Min
authors.initials: PM
authors.lastname: Hsieh
authors.forename: Yu Min
authors.initials: YM
authors.lastname: Hsieh
authors.forename: Bool Lee
authors.initials: BL
authors.lastname: Tan
authors.forename: Feng Chi
authors.initials: FC
authors.lastname: Chen
authors.forename: Tai Chien
authors.initials: TC
authors.lastname: Huang
authors.forename: Cheng-Cheng
authors.initials: CC
authors.lastname: Tung
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013154:Spleen / Q000293:injuries*; D013157:Splenic Artery / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000628:therapy*