ARRS 2022 Abstracts

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E1667. Splenic Artery Embolization: A Non-Invasive Intervention for Blunt Splenic Injury
Authors
  1. Meagan Prescott; University of South Carolina School of Medicine Greenville
  2. Olivia Corso; Pathology Associates
  3. Robert Eager; University of South Carolina School of Medicine Greenville
  4. Stella Self; Arnold School of Public Health
  5. Christine Schammel; Pathology Associates; University of South Carolina School of Medicine Greenville
  6. John Cull; Prisma Health
  7. Aron Devane; Prisma Health; University of South Carolina School of Medicine Greenville
Objective:
Although treatment for blunt splenic injury (BSI) has historically been splenectomy, treatment has shifted toward non-operative management (NOM) to prevent consequences of an immunocompromised, asplenic state, which elevates risk of life-threatening infection; however, NOM has failure rates as high as 34%. Splenic artery embolization (SAE) achieves hemostasis in BSI treatment via placement of embolic material within the proximal splenic artery (proximal SAE) or within the distal splenic artery (distal SAE) or both (combined SAE), improving success rates to 86–100%. Currently, it is unclear whether there are optimal embolization criteria for candidate selection, location, or material. Our goal was to investigate this at a single level I trauma center.

Materials and Methods:
A retrospective evaluation of all patients managed with SAE between 3/1/2016 and 12/31/2020 at a single institution was completed (n = 91). Data were stratified by vascular injury type, BSI grade, location, and material. Patients for whom complete records were not available were excluded. It was also noted independently if the patient’s splenic injury was associated with vascular injury: active extravasation/bleeding, pseudoaneurysm, AV Fistula, or a combination. Additionally, embolization site, technique, success of embolization, abscess formation, and overall outcomes were recorded and evaluated.

Results:
There was no difference in initial presentation when considering hemodynamic stability in ED (p = 0.3418), or focused assessment with sonography in trauma (FAST) abdominal results (p = 0.7896). Presence of vascular injury (p = 0.4388) and vascular injury type (p = 0.093) were not different when stratifying by grade of injury. Overall, 78% of SAE were proximal, 4.4% distal, and 17.6% combined. Stratification by location revealed significant differences in material usages. Amplatzer vascular plug was primarily used for proximal SAE (46.5%; n = 33); however, coil (38%; n = 27) or Amplatzer vascular plug and coil were used proximally (7%; n = 5, p < 0.001). For vascular injury type, the number of minor complications was significantly different between groups (p < 0.05); there were no differences in major complications. Most patients had high grade injuries (n = 77; grade III/IV/V) and thus required significantly more intervention (p = 0.01); however, major and minor complications were not significantly different between groups.

Conclusion:
Overall, SAE had 100% technical success and 94.5% primary clinical success, with a major complication rate of 6.6%; only 2.2% of patients had complications requiring splenectomy. SAE, regardless of location and material, appears to be an optimal non-surgical intervention for all grades of BSI. This study highlights the safety of SAE for patients regardless of clinical status.