Splenic salvage by superselective embolisation after blunt abdominal trauma

Angiography and embolisation for solid abdominal organ injury in adults - a current perspective

Over the past twenty years there has been a shift towards non-operative management (NOM) for haemodynamically stable patients with abdominal trauma. Embolisation can achieve haemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolisation techniques has widened the indications for NOM in the management of solid organ injury. Advances in computed tomography (CT) technology allow faster scanning times with improved image quality. These improvements mean that whilst surgery is still usually recommended for patients with penetrating injuries, multiple bleeding sites or haemodynamic instability, the indications for NOM are expanding.

We present a current perspective on angiography and embolisation in adults with blunt and penetrating abdominal trauma with illustrative examples from our practice including technical advice.

Follow-Up Abdominal CT is not Necessary in Low-Grade Splenic Injury

Nonoperative management of splenic injury has become the standard of care in the hemodynamically stable patient. The time period of observation and the utility of follow-up scanning remain an area of debate. This study examined the utility of follow-up abdominal CT for detection of delayed vascular injury in patients with low-grade splenic injury. A retrospective review of all patients with low-grade splenic injuries undergoing nonoperative management from June 2000 to June 2004 was performed. Patients underwent follow-up abdominal CT 48 to 72 hours after admission to rule out delayed vascular injury and were discharged if the results were negative. Charts were reviewed for demographic data, abdominal CT results, and splenic salvage. A total of 472 patients underwent nonoperative management for splenic injury, with 140 patients treated with simple observation during this protocol. All patients were successfully managed with simple observation with no nonoperative failures; there were two instances of delayed vascular injury on follow-up CT. Both patients with progression of injury had decreasing hematocrit levels during admission prior to follow-up abdominal CT scan. Overall, the injury severity score was 22 points and the American Association for the Surgery of Trauma (AAST) splenic injury severity score was 1.8 points. Length of hospital stay was 2.8 days for patients with predominately splenic injury and 10 days for the overall cohort. Follow-up abdominal CT confers no benefit in patients with low-grade splenic injury, and a stable hematocrit level and abdominal exam.