Abstract No. 431 A retrospective analysis of clinical outcomes in patients who underwent proximal versus distal splenic artery embolization for traumatic splenic injuries

Abstract

The purpose of this study is to assess clinical outcomes of splenic angioembolization in patients with traumatic splenic injuries, and to further assess which technique is associated with improved clinical outcomes (proximal versus distal embolization). 200 patients with traumatic splenic injuries were admitted to a level I trauma center from 10/2010 to 9/2017. The management method was determine using a retrospective analysis. Procedural reports were reviewed to determine whether a proximal or distal technique was used for embolization. Then, chart review was performed to record clinical outcome parameters including major rebleeding (requiring splenectomy), minor rebleeding (not requiring splenectomy), infection, and splenic inarction. Also, the AAST splenic injury grades were recorded. Outcomes were then compared between proximal and distal embolization, and stratified based on the AAST grades. 50 patients underwent splenectomy. 20 patients underwent splenic angioembolization (12 proximal, 6 distal, and 2 combination of proximal and distal). 5 of the total 20 patients (20%) had major rebleeding requiring splenectomy. The rate of major rebleeding for proximal embolization was 17% versus 33% for distal embolization. Of the 5 patients with major bleeding 4 had grade IV-V injuries and 1 had grades I-III injuries. In addition, 1 of the patients who had major rebleeding underwent a combination of proximal and distal embolization. The rate of minor rebleeding for proximal embolization was 8% compared to 0% for distal embolization. The rate of infarction for patients who had proximal embolization was 17% compared to 30% for distal embolization. Also, 1 out 2 patients undergoing a combination technique for embolization had a splenic infract. The rate of infection was 20% for the distal technique versus 0% for the proximal technique. The rate of major rebleeding requiring splenectomy is not statistically different for patients undergoing distal embolization compared to proximal embolization. Minor complications were higher in patients undergoing distal embolization. This data also suggests AAST grades IV-V should go straight to splenectomy.