Predicting splenic artery embolization outcomes in blunt trauma: results from a multicentre retrospective observational study

AimTo evaluate the association of anatomical, clinical, and procedural factors with endovascular treatment failure, including both proximal and distal splenic artery embolization (SAE).Material and methodsIn 11 centers, all patients following blunt splenic injury (BSI) were retrospectively evaluated, and those who had received SAE were selected. Data collected included: patient demographics and characteristics, mechanism and grading of BSI, endovascular management, and outcomes. Technical and clinical success were defined as successful embolization of the bleeding artery and stabilization of the haemodynamic status and laboratory data in 1 or 2 sessions, respectively. Rebleeding during follow-up and subsequent splenectomy were considered as treatment failure. The rate of complications related to the endovascular procedure was evaluated.ResultsThe management of two hundred and forty-seven participants was evaluated. Technical and clinical success were 100% and 91.9% (227/247), respectively. A second embolization was performed in 5 cases. Rescue splenectomy occurred in 20 (8.1%) patients.Statistically significant associations were identified between endovascular treatment failure and GCS and the presence of other lesions at CT at patient presentation. No anatomical or procedural factors were found to be statistically significant; in the surgical group, a larger diameter of the splenic artery was observed. The complication rate was 15.2% (26/171), all relating to the vascular access, e.g., hematoma or pseudoaneurysm, and all managed conservatively.ResultsThe management of two hundred and forty-seven participants was evaluated. Technical and clinical success were 100% and 91.9% (227/247), respectively. A second embolization was performed in 5 cases. Rescue splenectomy occurred in 20 (8.1%) patients.Statistically significant associations were identified between endovascular treatment failure and GCS and the presence of other lesions at CT at patient presentation. No anatomical or procedural factors were found to be statistically significant; in the surgical group, a larger diameter of the splenic artery was observed. The complication rate was 15.2% (26/171), all relating to the vascular access, e.g., hematoma or pseudoaneurysm, and all managed conservatively.ConclusionSAE is a safe and effective procedure; unsuccessful cases resulted statistically associated with some clinical factors, but no correlation with anatomical factors was observed.