Splenic Artery Embolization in Blunt Trauma

In prior decades, splenic arterial embolization (SAE) was used increasingly in the setting of nonoperative management of blunt splenic trauma. Recently, however, multiple studies have questioned the efficacy of SAE in the blunt trauma population; at the very least, the clinical indications for SAE appear to be changing.[1] At many institutions, however, including ours, SAE remains a mainstay in the treatment of patients suffering blunt trauma to the spleen.

Although there is evidence that in certain patient populations SAE improves outcome, the superiority of a specific technique (proximal embolization, distal embolization, or a combination of both) is still debated. This article briefly reviews indications, general techniques, and complications of SAE; specific attention is paid to our preferred technique for SAE, with an emphasis on the distinction between proximal and distal embolization.

• References

• 1 Smith HE, Biffl WL, Majercik SD, Jednacz J, Lambiase R, Cioffi WG. Splenic artery embolization: Have we gone too far?. J Trauma 2006; 61 (3) 541-544 ; discussion 545–546
• 2 Tinkoff G, Esposito TJ, Reed J , et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg 2008; 207 (5) 646-655
• 3 Shanmuganathan K, Mirvis SE, Boyd-Kranis R, Takada T, Scalea TM. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology 2000; 217 (1) 75-82
• 4 Bessoud B, Denys A, Calmes JM , et al. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization?. AJR Am J Roentgenol 2006; 186 (3) 779-785
• 5 Schnüriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma 2011; 70: 242-260