Emergent transcatheter arterial embolization in hemodynamically unstable patients with blunt splenic injury.
OBJECTIVE
Splenic preservation is currently the trend for treatment of patients with splenic trauma to avoid complications of splenectomy. This study aimed to evaluate the feasibility of emergent transcatheter arterial embolization (TAE) for hemodynamically unstable patients with blunt splenic injury.


METHODS
In a period of 2 years, 65 patients of blunt splenic trauma were studied. Patients with initial systolic blood pressure < 90 mmHg and showed initial response including rapid response and transient response to the emergent fluid resuscitation were included. Angiography and TAE was undertaken if contrast medium extravasation or pseudoaneurysm formation was noted in the computed tomography (CT) images, according to the criteria of American Association for the Surgery of Trauma. All patients who underwent TAE were admitted for observation of the possibility of delayed rupture.


RESULTS
Thirteen hemodynamically unstable patients who were responsive to initial fluid resuscitation received angiography due to abnormal CT findings including contrast agent extravasation in 12 patients, 2 patients with arteriovenous fistula, and 8 patients with pseudoaneurysm formation. TAE was successfully performed in all of these 13 patients, including 2 patients with associated left renal injuries and 1 patient associated with bilateral internal mammary arteries injuries, without complications.


CONCLUSIONS
TAE is a safe and effective procedure for treating blunt splenic injury even in hemodynamically unstable patients who responded to initial fluid resuscitation.
Lin
Wei-Ching
WC
Department of Radiology, China Medical University Hospital, No 2, Yuh-Der Road, Taichung, 40406, Taiwan, ROC.
Chen
Yung-Fang
YF
Lin
Chien-Heng
CH
Tzeng
Yuan-Hong
YH
Chiang
Hsein-Jar
HJ
Ho
Yung-Jen
YJ
Shen
Wu-Chung
WC
Chen
Jeon-Hor
JH
D000328:Adult; D000792:Angiography; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011379:Prognosis; D015641:Radiography, Interventional; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*
D003287:Contrast Media