Splenic trauma: endovascular treatment approach

Abstract

The spleen is a commonly injured organ in blunt abdominal trauma. Splenic preservation, however, is important for immune function and prevention of overwhelming infection from encapsulated organisms. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become an important component of non-operative management (NOM). SAE decreases the blood pressure to the spleen to allow healing, but preserves splenic perfusion via robust collateral pathways. SAE can be performed proximally in the main splenic artery, more distally in specific injured branches, or a combination of both proximal and distal embolization. No definitive evidence from available data supports benefits of one strategy over the other. Particles, coils and vascular plugs are the major embolic agents used.Incorporation of SAE in the management of blunt splenic trauma has significantly improved success rates of NOM and spleen salvage. Failure rates generally increase with higher injury severity grades; however, current management results in overall spleen salvage rates of over 85%. Complication rates are low, and primarily consist of rebleeding, parenchymal infarction or abscess. Splenic immune function is felt to be preserved after embolization with no guidelines for prophylactic vaccination against encapsulated bacteria; however, a complete understanding of post-embolization immune changes remains an area in need of further investigation. This review describes the history of SAE from its inception to its current role and indications in the management of splenic trauma. The endovascular approach, technical details, and outcomes are described with relevant examples. SAE is has become an important part of a multidisciplinary strategy for management of complex trauma patients.

Epidemiological profile of patients undergoing non-operative management of solid organ injury and associated factors with mortality

“…There was an association between the need for blood transfusion and the surgical approach. Several studies indicate that the need for blood products increases the risk of NOM failure 4,20,28 , but there was no such association in the present study.…”

Proximal splenic artery embolization using a vascular plug in grade IV or V splenic trauma – a single centre 11-year experience

“…The importance of the spleen in maintaining the body’s immune system and antibody production is well known, with knowledge that open splenectomy is strongly associated with systemic infection (Demetriades et al, 2012 ). Therefore, splenic preservation treatment options are important in the management of splenic trauma, with splenic artery embolization widely accepted as a safe and effective treatment in patients with hemodynamically stable grade III or higher splenic injury (Haan et al, 2005 ; Brahmbhatt et al, n.d. ; Cretcher et al, 2021 ; Quencer & Smith, 2019 ). Technical success was achieved in all patients in this study with grade IV or higher splenic trauma, comparable to the rates described in the literature (Habash et al, 2021 ; Frandon et al, 2014 ; Cinquantini et al, 2018 ).…”

“…SAE is a well documented procedure for splenic trauma, originally described by Sclafani in 1981 (Sclafani, 1981), offering a splenic preservation treatment (Habash et al, 2021;Patil et al, 2020;Haan et al, 2005;Brahmbhatt et al, n.d.;Olthof et al, 2017;Ahuja et al, 2015;Cretcher et al, 2021). The technique of proximal embolization, distal embolization, or combined embolization is well described in the literature, with comparable clinical outcomes (Jambon et al, 2018;Frandon et al, 2014;Wong et al, 2017;Gheju et al, 2013;Quencer & Smith, 2019;Cinquantini et al, 2018) and overall good splenic preservation.…”

A case report of successful splenic artery embolization for atraumatic splenic rupture secondary to Epstein Barr virus infection in a haemodynamically unstable patient

“…Splenic injury of AAST grade III or higher, evidence of active contrast extravasation and pseudoaneurysm formation are indications for SAE. SAE promotes hemostasis by reducing flow in the main splenic artery while preserving lower pressure flow to the splenic parenchyma by collateral vessels [5] . While preserving splenic function, SAE has achieved high success rates in managing splenic injuries from trauma in both children and adults [15] .…”

“…Management of splenic rupture historically involved operative management with splenectomy. In recent years, nonoperative management with splenic artery embolization (SAE) has become increasingly more prevalent in haemodynamically stable patients [2] , [3] , [4] , [5] . This report presents a case of the successful management of atraumatic splenic rupture in a hemodynamically unstable patient.…”