Negative Splenic Angiography in Blunt Trauma: Does Embolization Affect Splenic Salvage?
Angioembolization in blunt splenic trauma is used to maximize splenic preservation. Superiority of prophylactic embolization over expectant management in patients with a negative splenic angiography (SA) is debated. We hypothesized that embolization in negative SA would be associated with splenic salvage. Of 83 patients undergoing SA, 30 (36%) had a negative SA. Embolization was performed in 23 (77%). Grade of injury, contrast extravasation (CE) on computed tomography (CT) or embolization were not associated with splenectomy. In 20 patients with either a high-grade injury or CE on CT, 17 (85%) underwent embolization with a failure rate of 24%. In the remaining 10 without high-risk features, 6 underwent embolization with a 0% splenectomy rate. Despite embolization, the failure rate of nonoperative management (NOM) remains significant in those with high-grade injury or CE on CT. A low threshold for early splenectomy after prophylactic embolization is needed.
The American surgeon
Yoo, R., Evanson, D., Gaziano, M., Muller, A., Martin, A., Chauhan, N., Butts, C., Cortes, V., Reilly, E., Bamberger, K., Geng, T., & Ong, A. (2023). Negative Splenic Angiography in Blunt Trauma: Does Embolization Affect Splenic Salvage?. The American surgeon, 89 (7), 3209-3211. https://doi.org/https://doi.org/10.1177/00031348231157863