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Is splenic artery embolization beneficial when splenic angiography is negative? A multicenter observational study
Rachel Yoo1, Alison Muller, Carolyn Cook
1Division of Trauma and Surgical Critical Care (R.Y., A.M., A.O.), Reading Hospital, Reading, Pennsylvania; Department of Trauma Surgery (C.Co.), LSU Health, New Orleans, Louisiana; Department of Surgery (C.Ca), Grady Memorial Hospital, Atlanta, Georgia; Department of Surgery (D.C.), MaineHealth Maine Medical Center, Portland, Maine; Department of Surgery (P.O.U.), WakeMed, Raleigh, North Carolina; Divisionof Trauma Surgery (R.L.), Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana; Department of Surgery (R.S.J., J.M.), Stony Brook University Hospital, Stony Brook, New York; Department of Surgery (E.T.), Inova Fairfax Hospital, Fairfax, Virginia; Department of Surgery (C.M.H.), Baylor, Scott and White Health, Temple, Texas; Department of Surgery (L.C.), Northeast Georgia Medical Center, Gainesville, Georgia; Trauma & Acute Care Surgery (L.L.P.), Penn Medicine Lancaster General Health, Lancaster, Pennsylvania; Department of Surgery (K.L.), Ascension Sacred Heart Pensacola, Pensacola, Florida; Department of Surgery (G.C.), Mt. Sinai Hospital, Chicago, Illinois; Division of Trauma & Acute Care Surgery (M.M.), Los Angeles General Hospital, Los Angeles, California; Department of Surgery (L.E.J.), Ascension St. Vincent Hospital, Indianapolis, Indiana; Department of Trauma & Acute Care Surgery (C.T.), MedStar Washington Hospital Center, Washington, DC; Department of Surgery (B.S.R), Charleston Area Medical Center, Charleston, West Virginia; Department of Surgery (J.M.G), Sanford USD Medical Center, Sioux Falls, South Dakota; Department of Surgery (M.A.), Sanford Medical Center Fargo, Fargo, North Dakota; Department of Surgery (S.O.), East Carolina University Health Medical Center, Greenville, North Carolina; Division of Traumatology, Surgical Critical Care, and Emergency Surgery (M.S.), Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; Department of Surgery (N.B.), Tufts Medical Center, Boston, Massachusetts; Department of Mathematics, Statistics, and Computer Science (P.Z.), University of Illinois at Chicago, Chicago, Illinois.
Background:
While a positive splenic arteriography (SA) usually requires splenic artery embolization (SAE), the benefit of SAE after a negative SA is unclear. We hypothesized that SAE in patients with a negative SA would improve splenic salvage compared with no SAE.
Methods:
A multicenter, retrospective, observational study was performed across 21 level 1 and 2 trauma centers from 2018 to 2023. Included were blunt trauma patients who underwent both computed tomography and SA. Patients arriving more than 48 hours after injury or without admission computed tomography were excluded. The primary endpoint was splenectomy within 30 days. SA was categorized as positive or negative based on prespecified criteria. Among patients with negative SA, those who underwent SAE were compared with those who did not. Cox proportional hazards and frailty models assessed the relative risk for splenectomy.
Results:
Seven hundred twenty-six patients were included (median age, 44.5 y; median Injury Severity Score, 25). Of 332 with a negative SA, 80% underwent SAE. SAE was associated with lower splenectomy (5% vs. 16%, p =0.003) and mortality rates (2% vs. 10%, p =0.004). Adjusted Cox models showed reduced splenectomy risk with SAE when controlling for center splenectomy rate (HR, 0.33, 95% CI, 0.13-0.81, p =0.02) and urgent splenectomy rate (HR, 0.30, 95% CI, 0.13-0.65, p =0.005) but not when adjusting for SA utilization rate (HR, 0.69, 95% CI, 0.22-2.15, p =0.53) or including trauma center as a random effect (HR, 0.77, 95% CI, 0.27-2.30, p =0.65). Yet, complications requiring interventions after SAE (n=652) were not significantly different compared with those without SAE (n=74) (1.5% vs. 0%, p =0.34).
Conclusions:
In patients with negative SA, SAE was associated with reduced 30-splenectomy risk, but this association was not significant when including trauma center as a random effect. These findings suggest a possible association between SAE and splenic salvage in this selected cohort. ( J Trauma Acute Care Surg . 2026;101: 224-232. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
Level Of Evidence:
Therapeutic/Care Management; Level IV.
