Effect of Transcatheter Arterial Embolization Nonoperative management of blunt splenic trauma

ABSTRACT

BACKGROUND: This study was to access the hemostatic effectiveness of transcatheter arterial embolization (TAE) in a blunt splenic injury. We evaluated the efficacy of using detailed angiographic examnination and embolization for the nonsurgical management of patients with spleen injury. METHODS: Blunt splenic injuries diagnosed by Computed tomography (CT) between January 1997 and December 1997 were prospectively studied according to our management algorithm. The first group (G1) consisted of patients who were observed only, the second grourp (G2) with consisted of patients receving a TAE, and the third group (G3) consisted of those receving a laparotomy. The criteria for a TAE were 1) Type III or IV injury and 2) extravasation of contrast material revealed by CT. RESULTS: Of the total 46 patients with blunt splenic injury, 17 underwent emergency laparotomies because of associated injuries or unstable vital signs after resuscitation. Fourteen of the 17 had splenectomies and the other three had splenorrhaphies. The remaining 29 patients were considered for nonoperative management (63%), and 13 of them were selected for a TAE. Splenic angiography showed active bleeding in 12 and minor bleeding in one. The bleeding was successfully controlled by TAE in all 13 patients. Abdominal CT and scintigraphy taken after TAE disclosed well functioning spleens. The total splenic salvage rate was 63% in our patients. CONCLUSION: We could reduce the laparotomy rate and could preserve more spleens after application of TAE. Our success rate for splenic salvage should encourage more extensive use of a TAE for splenic injury.