Nonoperative Management of Splenic Injuries: Improved Results with Angioembolization

Abstract

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.

The splenic injury outcomes trial

“…Prior work studying various techniques aimed at splenic preservation are retrospective and primarily single center studies. (11)(12)(13)(19)(20)(21)(22)(23)(24)(25) Even the most recent guidelines published regarding the management of BSI are largely based on expert opinion and retrospective studies (26,27). This lack of consensus extends to the American Association for the Surgery of Trauma (AAST), where a survey demonstrated variability in the optimal management of BSI (28).…”

Treatment Option for High Grade Spleen Injury and Predictive Factors for Non-operative Management

“…All grade V patients underwent surgery; therefore we could not obtain information about high grade spleen injury angiographic embolization results. Gaarder et al [22] analyzed the effect of angiographic embolization in severe spleen injuries on outcomes measured by laparotomy and splenectomy rates for mandatory embolization in grade 3 to 5 whenever positive angiographic findings. They found that angiographic embolization use resulted in an increase of patients selected for NOM from 57% to 73% and failure rate decrease from 21% to 4% [22].…”

“…Gaarder et al [22] analyzed the effect of angiographic embolization in severe spleen injuries on outcomes measured by laparotomy and splenectomy rates for mandatory embolization in grade 3 to 5 whenever positive angiographic findings. They found that angiographic embolization use resulted in an increase of patients selected for NOM from 57% to 73% and failure rate decrease from 21% to 4% [22]. Another shortfall of our study was having no data about in high grade spleen injury patients converted from NOM to delayed operation.…”

Intraparenchymal Doppler ultrasound after proximal embolization of the splenic artery in trauma patients

“…Nonoperative management (NOM) has widely replaced operative intervention [4][5][6] with the main objective to preserve the splenic function [7,8]. Proximal embolization of the splenic artery has become an adjunct to NOM of severe splenic injuries in many trauma hospitals [3,[9][10][11][12][13]. In contrast to distal embolization at the bleeding site, proximal embolization of the main splenic artery does not directly stop the hemorrhage, but is supposed to enable clot formation in the hematoma by decreasing down-stream flow into the parenchyma [9,14].…”

“…During the last decades, a substantial change in the treatment of splenic injuries in adults has occurred [1][2][3]. Nonoperative management (NOM) has widely replaced operative intervention [4][5][6] with the main objective to preserve the splenic function [7,8].…”