Proximal splenic embolisation versus distal splenic embolisation for management of focal distal arterial injuries of the spleen

J Med Imaging Radiat Oncol. 2021 Dec;65(7):869-874. doi: 10.1111/1754-9485.13263. Epub 2021 Jun 17.

Abstract

Introduction: To compare the outcomes of proximal (pSAE) versus distal (dSAE) splenic artery embolisation for management of focal distal arterial splenic injuries secondary to blunt splenic trauma.

Method: Ethical approval was granted by the hospital research and ethics committee, Project 389/19. All patients who underwent splenic artery embolisation secondary to blunt abdominal trauma from 1 January 2009 to 1 January 2019 were reviewed. Patients with a tandem embolisation (both proximal and distal embolisations) or those with no acute vascular injury on angiography were excluded. Patient demographics, injury type/ AAST grade (2018 classification), technique of embolisation and outcomes were collected. Complications and splenectomy rates up to 30 days were recorded.

Results: 136 out of 232 patients had an embolisation performed for a distal vascular injury including active arterial bleeding, pseudoaneurysm or arteriovenous fistula. Mean age was 41 (range 16-84). Mean AAST grade was 4 (range 3-5). Mean Injury Severity Score was 22. pSAE was performed in 79.4% (n = 108) and dSAE in 20.6% (n = 28). Major complications occurred in 12 patients (pSAE n = 12, 11.1%; dSAE n = 0, P > 0.05); 6 pSAE required splenectomy (n = 6, 5.6%). There was no significant difference in outcomes between the two groups or when based on AAST grading.

Conclusion: No significant difference was observed between proximal and distal embolisation techniques for blunt trauma patients with a distal vascular injury in terms of technical and clinical success.

Keywords: AAST splenic injury grade; distal embolization; proximal embolisation; splenic embolisation; splenic injury.

MeSH terms

  • Abdominal Injuries* / diagnostic imaging
  • Abdominal Injuries* / therapy
  • Adult
  • Embolization, Therapeutic*
  • Humans
  • Retrospective Studies
  • Spleen / diagnostic imaging
  • Splenic Artery / diagnostic imaging
  • Treatment Outcome
  • Vascular System Injuries* / diagnostic imaging
  • Vascular System Injuries* / therapy