Usefulness of transarterial embolization in patients with blunt splenic injury showing transient response

Purpose

The usefulness of transarterial embolization (TAE) in patients with blunt splenic injury has been recently reported. However, TAE can be performed only in patients who are hemodynamically stable on admission or who rapidly respond to fluid resuscitation (rapid response) according to the Advanced Trauma Life Support. The present study was performed in order to clarify whether nonsurgical management using TAE could be performed even in patients who transiently respond to fluid resuscitation (transient response).

Methods

Contrast CT was performed in the patients with blunt abdominal injuries except those who did not respond to fluid resuscitation. Angiography was performed in patients who had contrast extravasation and/or had splenic injury of AAST grade ≥ 3 on CT. TAE was performed when angiography showed disruption of the terminal arteries or arterial extravasation. When the patients had complicated injuries, TAE of these complicated lesions was simultaneously performed.

Results

Of 104 patients with splenic injury who were admitted to our hospital between January 1999 and August 2002, 73 received contrast CT. Forty of these 73 patients were in shock status on admission (SBP ≤ 90 mmHg, shock index ≥ 1). Twenty-two of the 40 patients showed rapid response. Among them, 16 received TAE and nonsurgical managements were successfully performed in all these patients. The remaining 18 patients showed transient response. The one patient went into no response after CT and received emergent laparotomy. Therefore, 17 patients were subjects of the present study. The subjects were 11 males and six females at the mean age of 37.1 ± 19.7 years with a mean ISS score of 34.6 ± 19.7. Two patients had AAST Grade III, 13 Grade IV, and two Grade V. TAE for splenic injury was performed for all the 17 patients. Seven patients had complicated injuries that required TAE (one had renal injury of AIS 4 and pelvic fracture of AIS 4; one hepatic injury of AIS 4 and pelvic fracture of AIS 4; two pelvic fracture of AIS 4; two hepatic injury of AIS 4; and one facial injury of AIS 4 and hepatic injury of AIS 4). TAE of spleen and complicated lesions was successfully performed on all the patients. Systolic blood pressure before and after TAE was 79.3 ± 16.9 and 128.3 ± 20.5 mmHg, respectively (P < 0.001). Shock index before and after TAE was 1.6 ± 0.6 and 0.8 ± 0.2, respectively (P < 0.001). Fluid resuscitation required after TAE (196.2 ± 194.7 ml/hour) significantly decreased compared with that required before TAE (1169.5 ± 287.4 ml/hour) (P < 0.01). Two patients died of cerebral hernia after head injuries.

Conclusion

TAE for blunt spleen injury could be successfully performed in patients showing transient response. TAE could be the first-choice treatment for splenic injury in patients other than those showing no response.