Time to Splenic Angioembolization Does Not Impact Splenic Salvage Rates.

Area of Science:

• Trauma Surgery
• Interventional Radiology
• Emergency Medicine

Background:

• Blunt splenic trauma management involves complex decisions regarding intervention timing.
• Splenic angioembolization (SAE) is a key technique for managing splenic injuries.
• The optimal timing for SAE after blunt splenic trauma remains debated.

Purpose of the Study:

• To compare early (<6 hours) versus delayed (≥6 hours) splenic angioembolization (SAE) impact on splenic salvage rates.
• To evaluate the effect of SAE timing on the need for delayed splenectomy in patients with blunt splenic trauma (grades II-V).
• To determine if SAE timing influences successful splenic salvage.

Main Methods:

• Retrospective analysis of 226 patients with blunt splenic trauma treated at a Level I trauma center (2016-2021).
• Patients were categorized into early (<6 hours) and delayed (≥6 hours) SAE groups.
• Primary outcome: delayed splenectomy. Secondary outcomes: splenic salvage rates, time to SAE for successful vs. failed salvage.

Main Results:

• The early SAE group had higher injury severity (AAST grade, hemoperitoneum) and a 3.9x increased odds of delayed splenectomy (P = .046).
• Patients who failed splenic salvage had a shorter time to embolization (5 vs. 10 hours, P = .051).
• Multivariate analysis indicated that the timing of SAE did not significantly affect splenic salvage rates.

Conclusions:

• Early (<6 hours) splenic angioembolization does not appear to improve splenic salvage rates compared to delayed (≥6 hours) intervention.
• The timing of SAE has no significant effect on overall splenic salvage in blunt splenic trauma.
• Performing SAE on an urgent, rather than emergent, basis is supported for stable patients with blunt splenic injury.