Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

Abstract

Purpose To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Materials and Methods Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. Results Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation-a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. Conclusion IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

Evidence-Based Management and Controversies in Blunt Splenic Trauma

“…There was no difference between the patients with proximal and distal embolisation (7.55 (6.11–9.31) vs. 9.97 (6.75–14.74)). However, there was a significant difference between the control group and the proximally embolised group (10.75 (9.58–12.06) vs. 7.55 (6.11–9.31)); p value 0.02) [ 34 ]. Currently, a multicenter trial is being conducted (by the Davis Medical Center of the University of California) in which a total number of 90 patients will be enrolled (30 patients treated with observation, 30 with embolisation, and 30 operatively treated patients) and compared with regard to splenic function, measured by geometric mean increases in pneumococcal antibody titre [ 35 ].…”

Spleen Australia guidelines for the prevention of sepsis in patients with asplenia and hyposplenism in Australia and New Zealand

“…Quantification of IgM memory B cells may be of use for predicting an individual's capacity to mount an immune response to encapsulated bacteria following splenectomy. A large study found minimal evidence of hyposplenism following embolisation . Another study on patients with portal hypertension/cirrhosis who underwent SAE also had a significant number of patients not found to be hyposplenic …”

“…A large study found minimal evidence of hyposplenism following embolisation. 16,17 Another study on patients with portal hypertension/cirrhosis who underwent SAE also had a significant number of patients not found to be hyposplenic. 18 Ultrasound and computerised tomography can be used to identify the presence of the spleen or splenic tissue, but the size of the residual tissue does not reliably correlate with function.…”

Nonoperative Management of Splenic Trauma: An Update

“…Foley and colleagues looked specifically at B cell and B cell IgM memory and showed no statistical difference among embolization technique, with preservation of innate immunity among embolized spleens compared with splenectomy. 23 This is important given potential fatal infection outcomes associated with patients requiring splenectomies.…”