Digestive Disease Interventions
DOI: 10.1055/s-0045-1807245
Review Article

Endovascular Management of Traumatic Splenic Lacerations

Sheridan Reed
1   Radiology and Medical Imaging – Division of Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, Virginia
,
Chandler Fountain
1   Radiology and Medical Imaging – Division of Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, Virginia
,
Luke Wilkins
1   Radiology and Medical Imaging – Division of Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, Virginia
› Author Affiliations
Funding None.

Abstract

Splenic injury in the setting of traumatic injury can lead to significant blood loss and hemodynamic instability. Splenic artery embolization and thus the role of interventional radiologists in the management of these injuries has continued to increase, as studies have shown a decrease in all-cause mortality for patients who are managed nonoperatively. There are multiple techniques for embolization including proximal, distal, and combined embolization as well as several embolic materials that can be used. This allows treatment to be tailored to the patient and their grade of injury as determined by the American Association for the Surgery of Trauma Splenic Injury Scale. It is important for interventional radiologists to understand the expected procedural outcomes, possible complications, and postprocedural management of these patients.



Publication History

Received: 16 January 2025

Accepted: 06 March 2025

Article published online:
08 April 2025

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  • References

  • 1 Zarzaur BL, Rozycki GS. An update on nonoperative management of the spleen in adults. Trauma Surg Acute Care Open 2017; 2 (01) e000075
  • 2 Manatakis DK, Piagkou M, Loukas M. et al. A systematic review of splenic artery variants based on cadaveric studies. Surg Radiol Anat 2021; 43 (08) 1337-1347
  • 3 Sangster GP, Malikayil K, Donato M, Ballard DH. MDCT findings of splenic pathology. Curr Probl Diagn Radiol 2022; 51 (02) 262-269
  • 4 Uyeda JW, LeBedis CA, Penn DR, Soto JA, Anderson SW. Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT. Radiology 2014; 270 (01) 99-106
  • 5 Thippeswamy PB, Rajasekaran RB. Imaging in polytrauma - principles and current concepts. J Clin Orthop Trauma 2020; 16: 106-113
  • 6 Kozar RA, Crandall M, Shanmuganathan K. et al; AAST Patient Assessment Committee. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg 2018; 85 (06) 1119-1122
  • 7 Rong JJ, Liu D, Liang M. et al. The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis. Mil Med Res 2017; 4: 17
  • 8 Tran S, Wilks M, Dawson J. Endovascular management of splenic trauma. Surg Pract Sci 2022; 8: 100061
  • 9 Quencer KB, Smith TA. Review of proximal splenic artery embolization in blunt abdominal trauma. CVIR Endovasc 2019; 2 (01) 11
  • 10 Habash M, Ceballos D, Gunn AJ. Splenic artery embolization for patients with high-grade splenic trauma: indications, techniques, and clinical outcomes. Semin Intervent Radiol 2021; 38 (01) 105-112
  • 11 Davies DA, Pearl RH, Ein SH, Langer JC, Wales PW. Management of blunt splenic injury in children: evolution of the nonoperative approach. J Pediatr Surg 2009; 44 (05) 1005-1008
  • 12 Shinn K, Gilyard S, Chahine A. et al. Contemporary management of pediatric blunt splenic trauma: a national trauma databank analysis. J Vasc Interv Radiol 2021; 32 (05) 692-702
  • 13 Waseem M, Bjerke S. Splenic injury. In: StatPearls. StatPearls Publishing; 2024. . Accessed September 20, 2024 at: http://www.ncbi.nlm.nih.gov/books/NBK441993/
  • 14 Sinwar PD. Overwhelming post splenectomy infection syndrome - review study. Int J Surg 2014; 12 (12) 1314-1316
  • 15 ACIP Altered Immunocompetence Guidelines for Immunizations | CDC. July 22, 2024. Accessed November 11, 2024 at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html
  • 16 Schimmer JAG, van der Steeg AFW, Zuidema WP. Splenic function after angioembolization for splenic trauma in children and adults: a systematic review. Injury 2016; 47 (03) 525-530
  • 17 Freeman JJ, Yorkgitis BK, Haines K. et al. Vaccination after spleen embolization: a practice management guideline from the Eastern Association for the Surgery of Trauma. Injury 2022; 53 (11) 3569-3574
  • 18 Slater SJ, Lukies M, Kavnoudias H. et al. Immune function and the role of vaccination after splenic artery embolization for blunt splenic injury. Injury 2022; 53 (01) 112-115
  • 19 Bankhead-Kendall B, Slama EM, Robinson RB, Teixeira PG. Vaccination practices in trauma patients undergoing splenic artery embolization: a split practice. Am Surg 2020; 86 (09) 1202-1204
  • 20 Jones B, Elbakri AS, Murrills C, Patil P, Scollay J. Splenic artery embolisation for blunt splenic trauma: 10 years of practice at a trauma centre. Ann R Coll Surg Engl 2024; 106 (03) 283-287
  • 21 Pillai AS, Srinivas S, Kumar G, Pillai AK. Where does interventional radiology fit in with trauma management algorithm?. Semin Intervent Radiol 2021; 38 (01) 3-8
  • 22 Padia SA, Ingraham CR, Moriarty JM. et al. Society of Interventional Radiology Position Statement on endovascular intervention for trauma. J Vasc Interv Radiol 2020; 31 (03) 363-369.e2