Splenic artery embolization for trauma: a narrative review.

Area of Science:

• Trauma surgery
• Interventional radiology
• Surgical oncology

Background:

• Management of traumatic splenic injuries has shifted towards nonoperative approaches.
• Hemodynamic instability dictates surgical intervention; otherwise, conservative management is employed.
• Conservative treatment includes medical management and splenic artery angiography with embolization for hemorrhage.

Purpose of the Study:

• To review the evolution and current strategies in managing traumatic splenic injuries.
• To delineate the role of nonoperative management and splenic artery embolization.
• To highlight differences in infection risk between patients with retained splenic tissue and post-splenectomy patients.

Main Methods:

• Review of current literature and clinical practice guidelines.
• Categorization of splenic artery embolization into proximal and distal techniques.
• Assessment of factors influencing embolization technique selection based on injury severity and location.

Main Results:

• The majority of traumatic splenic injuries are managed nonoperatively.
• Splenic artery embolization is a key component of conservative management for active hemorrhage.
• Proximal and distal embolization techniques are chosen based on injury characteristics.
• Patients with retained splenic tissue do not require routine immunization, unlike post-splenectomy patients.

Conclusions:

• Nonoperative management is the preferred approach for hemodynamically stable patients with traumatic splenic injuries.
• Splenic artery embolization is effective in controlling hemorrhage and preserving splenic function.
• Understanding infection risks is crucial, with post-splenectomy patients requiring specific prophylactic measures.