Nonoperative management of splenic injuries: improved results with angioembolization.
BACKGROUND
Nonoperative management (NOM) of patients with severe splenic injuries carries a significant risk of failure. We hypothesized that adding angiographic embolization (AE) to the NOM protocol would decrease the laparotomy rate, and increase the success rate of NOM and splenic salvage rate.


METHODS
A protocol introducing AE in the treatment of splenic injuries was implemented. AE was performed in OIS splenic injury grades 3 to 5 and in all cases where signs of ongoing bleeding were encountered regardless of injury grade. Patients included in a prospective study during a 24-month period were compared with a historic control group.


RESULTS
Group 1 (before AE) consisted of 69 patients with a mean Injury Severity Score (ISS) of 31, and group 2 (after introducing AE) included 64 patients with a mean ISS of 30. In group 1, 30 patients underwent immediate laparotomy (43%), and the NOM success rate was 79%. After introducing AE, 17 patients underwent immediate laparotomy (27%; p = 0.04), with a NOM success rate of 96% (p = 0.02). Overall splenic salvage rate increased from 57% to 75% (p = 0.02). Angiography was performed in 31 patients in group 2. Embolization was performed in 27 of these patients. AE failure rate was 4%. NOM was successful in 14 of 15 patients with OIS injury grades 4 and 5 after the introduction of AE (93%).


CONCLUSIONS
A formal protocol adding mandatory AE to NOM for severe splenic injuries increased the percentage of patients in whom NOM was attempted, the NOM success rate, and the splenic salvage rate.
Gaarder
Christine
C
Ullevaal University Hospital, Oslo, Norway. tinagaar@online.no
Dormagen
Johann Baptist
JB
Eken
Torsten
T
Skaga
Nils Oddvar
NO
Klow
Nils Einar
NE
Pillgram-Larsen
Johan
J
Buanes
Trond
T
Naess
Paal Aksel
PA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000628:therapy