Midwest Surgical Association
Complications arising from splenic artery embolization: a review of an 11-year experience

Presented at the 55th Annual Meeting of the Midwest Surgical Association, Mackinac Island, MI, August 5–8, 2012.
https://doi.org/10.1016/j.amjsurg.2013.01.003Get rights and content

Abstract

Background

Splenic artery embolization (SAE) is a staple adjunct in the management of blunt splenic trauma. We examined complications of SAE over an 11-year period.

Methods

Patients who underwent SAE were identified. Demographic data and the location of the SAE—proximal, distal, or combined—were noted. Major and minor complications were identified.

Results

Of 1,383 patients with blunt splenic trauma, 298 (21.5%) underwent operative management, and 1,085 (78.5%) underwent nonoperative management (NOM). SAE was performed in 8.1% of the NOM group. Major complications which occurred in 14% of patients, included splenic abscesses, infarction, cysts, and contrast-induced renal insufficiency. Three-fourths of patients with major complications underwent distal embolization. There were more complications in patients who underwent distal embolization (24% distal vs 6% proximal alone; P = .02). Minor complications, which occurred in 34% of patients, included left-sided pleural effusions, coil migration, and fever.

Conclusions

SAE is a useful tool for managing splenic injuries. Major and minor complications can occur. Distal embolization is associated with more major complications.

Section snippets

Methods

Trauma registry (TraumaBase, Clinical Data Management, Evergreen, CO) and medical record information of patients with splenic injuries admitted to Miami Valley Hospital (an American College of Surgeons–verified level I trauma center) between January 2000 and December 2010 were reviewed. Patients were grouped by the type of management of their splenic injury: operative or nonoperative. Individuals who underwent SAE were selected for detailed analysis. Age, sex, length of stay, associated

Results

During the 11-year period studied, 1,383 patients with blunt splenic trauma were admitted to Miami Valley Hospital. There were 298 patients (21.5%) who underwent eventual operative management and 1,085 patients (78.5%) who were successfully managed nonoperatively.

In the NOM group, 91 patients underwent splenic angiography with the intent to perform SAE. Three of these patients did not undergo a completed SAE procedure. In 1 of these 3 patients, with a grade II splenic lesion and active pelvic

Comments

Most of the recent literature regarding SAE has focused on outcomes primarily from the standpoint of successful NOM and the avoidance of splenectomy. Few authors have explored complications of the procedure. Evaluating complications is an important aspect of determining the value of any procedure and determining the risks and benefits.

Our previous study on complications of SAE, which had a small number of patients, reported a major complication rate of 27% and a minor complication rate of 53%.

Conclusions

In summary, SAE is a very useful tool for managing splenic injuries. Major and minor complications can occur and should be included in the risk-benefit analysis. Distal embolization is significantly associated with more major complications.

References (14)

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    With the increasing use of splenic artery embolization, recognition of its complication rate is imperative. Previous studies at Miami Valley Hospital in Dayton, Ohio have examined complication rates with the most recent examining complications from 2000 to 2010.16,17 The goal of the current study was to examine the rates of major and minor complications in patients who underwent splenic artery embolization from January 2011 through November 2018 and to compare this data to the prior period studied.

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