Negative Splenic Angiography in Blunt Trauma: Does Embolization Affect Splenic Salvage?

Area of Science:

• Trauma Surgery
• Interventional Radiology
• Surgical Outcomes

Background:

• Splenic preservation is a goal in blunt splenic trauma.
• The role of prophylactic angioembolization in patients with negative splenic angiography is debated.
• Nonoperative management (NOM) is increasingly utilized for splenic injuries.

Purpose of the Study:

• To evaluate the association between prophylactic splenic angioembolization and splenic salvage in patients with negative splenic angiography.
• To determine if angioembolization impacts splenectomy rates in blunt splenic trauma.
• To identify patient subgroups where NOM with angioembolization may be less successful.

Main Methods:

• Retrospective review of 83 patients undergoing splenic angiography (SA) for blunt splenic trauma.
• Analysis of 30 patients with negative SA, of whom 23 underwent angioembolization.
• Comparison of splenectomy rates based on injury grade, CT findings (contrast extravasation), and embolization status.

Main Results:

• Of 30 patients with negative SA, 23 (77%) received angioembolization.
• Injury grade, CT contrast extravasation, or embolization were not associated with splenectomy.
• In high-risk patients (high-grade injury or CT CE), embolization had a 24% failure rate, necessitating splenectomy.
• In low-risk patients, embolization resulted in a 0% splenectomy rate.

Conclusions:

• Prophylactic angioembolization in patients with negative splenic angiography did not significantly improve splenic salvage rates.
• Nonoperative management failure remains significant in high-grade blunt splenic injuries or those with CT contrast extravasation, even after embolization.
• A low threshold for early splenectomy should be considered in high-risk patients undergoing prophylactic embolization for blunt splenic trauma.