Splenic artery embolization: technically feasible but not necessarily advantageous. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Van der Cruyssen, F.; Manzelli, A.
• Is Part Of: World journal of emergency surgery. Volume 11:Issue 1(2016)
• Page Start: 1
• Page End: 14
• Publication Date: 2016-12
• Subjects: Splenic artery -- Embolization -- Blunt splenic injury -- Nonoperative management -- Operative splenic salvage -- Splenectomy -- Trauma; Surgical emergencies -- Periodicals; Surgery -- Periodicals; 617.026
• DOI: 10.1186/s13017-016-0100-7
• Languages: English
• ISSNs: 1749-7922

Abstract

Abstract Background The spleen is the second most commonly injured organ in cases of abdominal trauma. Management of splenic injury depends on the clinical status of the patient and can include nonoperative management (NOM), splenic artery embolization (SAE), surgery (operative splenic salvage or splenectomy), or a combination of these treatments. In nonoperatively managed cases, SAE is sometimes used to control haemorrhage. However, the indications for SAE have not been clearly defined and, in some cases, the potential complications of the procedure may outweigh its benefits. Review of the literature Through review of the literature we address the question of when SAE is indicated in combination with NOM of splenic injury, and whether SAE may delay needed surgical treatment in some cases. This systematic review highlighted the use of imperfect and inconsistent scoring systems in the diagnosis of splenic injury, the lack of consensus regarding indications for SAE, and the potential for severe morbidities associated with this procedure. Based on current literature and evidence we provide a new, non-verified, decision algorithm. Conclusions NOM+ SAE involves potential risks and operative management may be preferable to SAE for certain patients. To clarify current literature, we propose a new algorithm for blunt abdominal trauma that should be validated prospectively. New evidence-based protocols should be developed to guide diagnosis and management of patients with splenic trauma.