IMPROVED SUCCESS IN NONOPERATIVE MANAGEMENT OF BLUNT SPLENIC INJURIES- EMBOLIZATION OF SPLENIC ARTERY PSEUDOANEURYSMS

Objectives: By using abdominal computed tomographic scans in the evalu ation of blunt splenic trauma, we previously identified the presence o f vascular blush as a predictor of failure, with a failure of nonopera tive management of 13% in that series. This finding led to an alterati on in our management scheme, which now includes the aggressive identif ication and embolization of splenic artery pseudoaneurysms, Methods: T he medical records of 524 consecutive patients with blunt splenic inju ry managed over a 4.5-year period were reviewed for the following info rmation: age, Injury Severity Score (ISS), American Association for th e Surgery of Trauma splenic injury grade (SIG), method and outcome of management, Results: Of the patients, 66% were male with a mean age of 32 +/- 16, and mean ISS of 25 +/- 13, A total of 180 patients (34%) w ere managed with urgent operation on admission (81% splenectomy (SIG 4 .0), 19% splenorrhaphy (SIG 2.6)), The remaining 344 patients (66%) we re hemodynamically stable and underwent computed tomographic scan and planned nonoperative management. Of these patients, 322 patients (94%) were successfully managed nonoperatively (61% of total splenic injuri es), In 26 patients (8%), a contrast blush identified on computed tomo graphic scan was confirmed as a parenchymal pseudoaneurysm on arteriog raphy, Twenty patients (SIG, 2.8) were successfully embolized, In six patients, technical failure precluded embolization; all required splen ectomy (SIG, 4.0), A total of 22 patients (6%) failed nonoperative man agement, including the six with unsuccessful embolization attempts, Si xteen patients (SIG, 3.0) who had no evidence of pseudoaneurysm were e xplored for a falling hematocrit, hemodynamic instability, or a worsen ing follow-up computed tomography: 13 patients had splenectomy, and th ree patients had splenorrhaphy. Conclusions: Aggressive surveillance f or and embolization of posttraumatic splenic artery pseudoaneurysms im proved the rate of successful nonoperative management of blunt splenic trauma to 61%, with a nonoperative failure rate of only 6%. In compar ison with our previous work, this reduction in failure of nonoperative management is a significant improvement (p < 0.03).