Literature review of the role of ultrasound, computed tomography, and transcatheter arterial embolization for the treatment of traumatic splenic injuries.
BACKGROUND
The spleen is the second most frequently injured organ following blunt abdominal trauma. Trends in management have changed over the years. Traditionally, laparotomy and splenectomy was the standard management. Presently, nonoperative management (NOM) of splenic injury is the most common management strategy in hemodynamically stable patients. Splenic injuries can be managed via simple observation (OBS) or with angiography and embolization (AE). Angio-embolization has shown to be a valuable alternative to observational management and has increased the success rate of nonoperative management in many series.


METHODS
Improved imaging techniques and advances in interventional radiology have led to a better selection of patients who are amenable to nonoperative management. Despite this, there is still a lot of debate about which patients are prone to NOM.
The optimal patient selection is still a matter of debate and the role of CT and angio-embolization has not yet fully evolved. We discuss the role of sonography and CT features, such as contrast extravasation, pseudoaneurysms, arteriovenous fistulas, or hemoperitoneum, to determine the optimal patient selection for angiography and embolization. We also review the efficiency, technical considerations (proximal or selective embolization), logistics, and complication rates of AE for blunt traumatic splenic injuries.
van der Vlies
Cornelis H
CH
Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. c.h.vandervlies@amc.nl
van Delden
Otto M
OM
Punt
Bastiaan J
BJ
Ponsen
Kees J
KJ
Reekers
Jim A
JA
Goslings
J Carel
JC
D000792:Angiography; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D018579:Patient Selection; D015641:Radiography, Interventional; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional; D014611:Vaccination; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*
D003287:Contrast Media