Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up.
BACKGROUND
To evaluate the clinical, US (ultrasound)-Doppler and hematologic findings after proximal splenic artery embolization (PSAE) for blunt injury.


METHODS
From August 1998 to February 2003, 37 patients (28 men and 9 women; 20-89 years old, mean 40 years) underwent PSAE for blunt injuries. One patient required secondary splenectomy after PSAE. Early complications were investigated during the hospital stay. Delayed follow-up included review of the outpatient records, telephone interview, consultation, US-Doppler splenic study, Howell-Jolly body search, and serum antibody titer determinations (pneumococcus and Haemophilus influenzae B).


RESULTS
No early postprocedural complications were depicted. Ten patients were lost on follow-up. Two patients had a telephone interview that revealed no complication. Twenty-four patients were examined 6 to 63 (mean 26) months after the embolization. No late complication was reported. Splenic measurements were in the normal range: length (53-110 mm; mean, 73), width (49-110 mm; 76), thickness (26-56 mm; 38), volume (61-508 mL; 226), standard ellipsoid formula volume (32-265 mL; 118), corrected volume (29-238 mL; 106), and splenic volumetric index (2.3-18.8; 8.4). The spleen was homogeneous in 23 patients (96%). Intrasplenic vascularization was present and splenic vein was patent in all patients. Howell-Jolly bodies were found in two patients. All patients (24 of 24) evaluated for exposure-driven immunity against Haemophilus Influenza b had sufficient immunity. Seventeen of the 18 patients (94%) evaluated for exposure-driven immunity against pneumococcus had sufficient immunity. Five of the six patients (83%) evaluated for pneumococcus vaccine response had a sufficient response.


CONCLUSIONS
Proximal splenic artery embolization in blunt splenic injuries is a well-tolerated technique without major long-term impact on the splenic anatomy and immune function.
Bessoud
Bertrand
B
Department of Radiology and Interventional Radiology, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. bertrand.bessoud@bct.ap-hop-paris.fr
Duchosal
Michel A
MA
Siegrist
Claire-Anne
CA
Schlegel
Susanna
S
Doenz
Francesco
F
Calmes
Jean-Marie
JM
Qanadli
Salah D
SD
Schnyder
Pierre
P
Denys
Alban
A
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000276:immunology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000293:injuries*; D013157:Splenic Artery / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014949:Wounds, Nonpenetrating