Jay Anthony Requarth MD, Presenter: Nothing to Disclose

Preston R. Miller MD, Abstract Co-Author: Nothing to Disclose

Michael C. Chang MD, Abstract Co-Author: Nothing to Disclose

John D. Regan MD, Abstract Co-Author: Nothing to Disclose

Michael Alfred Bettmann MD, Abstract Co-Author: Medical Advisory Board, Bracco Group Medical Advisory Board, AngioDynamics, Inc Consultant, Schering AG (Berlex Inc)

Non-operative therapy (NOT) in hemodynamically stable patients with splenic trauma is the standard of care. The trauma surgical literature suggests that splenectomy follows as many as 27% of splenic artery embolizations (SAE). Many of the factors regarding the success or failure in SAE have not been studied. This review evaluates the risk of SAE failure as a function of location of embolization.

We evaluated all patients, using electronic medical records and radiographic images, who were admitted to this level I trauma hospital in 2004 and 2005. Written reports detailing the radiographic images were accepted if the images were not available for review. The embolization technique utilized coils exclusively.

In 2004 and 2005, 277 patients were admitted with the diagnosis of splenic trauma. Twenty-three were treated initially with non-operative therapy with arteriography +/- embolization because a contrast enhanced CT scan suggested a splenic vascular injury. Three additional patients underwent arteriography: 1 who failed surgery and 2 who failed initial NOT. Thus, a total of 26 patients underwent angiography. Six of these patients had a normal arteriogram, did not receive embolization, and did well. The other 20 patients had a vascular injury demonstrated on angiography: 12 pseudoaneurysm +/- arteriovenous fistula, 1 abnormal truncated artery, 7 extravasation. Two patients with small pseudoaneurysms were not embolized, and 9 were treated with distal splenic artery embolization +/- distal branch embolization; all 11 patients did well. However, 3 of the 9 patients, who received distal branch embolization only, developed delayed hemorrhage and 2 required splenecomy and 1 required additional embolization therapy.

Distal splenic artery branch embolization alone may be ineffective and may result in delayed hemorrhage of the traumatically injured spleen. These results suggest that additional embolization in the proximal or distal splenic artery may be necessary to prevent delayed hemorrhage.

The traumatically injured spleen may require distal branch embolization for immediate control of hemorrhage and more proximal embolization to prevent delayed hemorrhage.

Requarth, J, Miller, P, Chang, M, Regan, J, Bettmann, M, Isolated Distal Splenic Artery Branch Embolization in Patients with Splenic Vascular Trauma May Be Ineffectve.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4438135.html