Kurt A. Schoppe MD, Abstract Co-Author: Nothing to Disclose

Daniel C. Brown MD, Presenter: Nothing to Disclose

Jay Anthony Requarth MD, Abstract Co-Author: Nothing to Disclose

Evaluate outcomes of adult blunt splenic injury (BSI) patients treated with a novel protocol based on splenic injury grade and distal splenic artery "stump" pressure determined during transient occlusion of the splenic artery (see figure). The BSI algorithm includes; 1) contrast enhanced CT to ascertain splenic injury grade and presence of vascular injury, 2) high grade BSI is a diffuse injury requiring distal and proximal intervention, 3) intraparenchymal splenic vascular injuries are to be treated with distal embolotherapy, 4) systolic splenic artery stump to aortic pressure gradient needs to be greater than 50% for embolotherapy to be adequate treatment.

Between 1/1/2010 and 3/23/2011, 39 hemodynamically stable adult BSI patients with grade 3-5 splenic trauma were referred for splenic artery angiography ± embolotherapy using the new algorithm. Patients with evidence of parenchymal vascular injury (e.g. pseudoaneurysm, extravasation, or arteriovenous fistula) received distal embolization. Thereafter the distal splenic artery stump to aortic pressure gradient was determined. If there was a significant drop in pressure in the splenic artery, then the proximal splenic artery was occluded; however, patients with insufficient pressure gradient were referred for splenectomy. Failure was defined as delayed splenic hemorrhage requiring splenectomy or repeat embolotherapy.  

Thirty-nine patients were referred for angiography; 23 men and 16 women. The average age was 38 ± 19 years and the average splenic injury grade was 3 ± 0.7. Overall, 4 of the 39 patients failed the index treatment (10%). Only 25 (64%) of the patients were treated according to the new BSI algorithm. Of those treated according to protocol, no failures occured; however, of the 14 patients not treated according to protocol, 4 (29%) failed treatment (P=0.01).  

The novel BSI treatment reviewed here uses both CT imaging and hemodynamic data to determine treatment with significantly improved results compared with published failure rates of 16% for splenic artery embolization across all injury grades and 10%,  44%, and 84% with non-operative management in patients with splenic injury grades 3, 4, and 5, respectively.

Implementation of a novel protocol for managing blunt splenic injuries successfully decreases treatment failure rates.

Schoppe, K, Brown, D, Requarth, J, Initial Results of a Novel Blunt Splenic Injury Treatment Algorithm.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11007721.html