Splenic Artery Embolization in High Grade Splenic Injury and Polytrauma: Safety and Efficacy

High grade splenic injury (American Association for Surgery of Trauma [AAST], Grade IV-V) is managed by splenectomy in 95% of patients, unchanged from 2007 to 2024 {1-3}. We validate the use of splenic artery embolization (SAE) in non-operative management (NOM) for high grade splenic injury in complex polytrauma and hemodynamically (HD) unstable patients.

Materials and Methods:

A retrospective study was performed including 278 patients (Table 1 for characteristics), who underwent SAE at a Level 1 trauma center from 9/1/2015 to 9/1/2024. Polytrauma was defined Abbreviated Injury Score >3 of concurrent non-abdominal trauma {4}. Pre-intervention systolic pressure < 90 mmHg defined HD unstable. Primary endpoints include adverse events (splenic infarction, bleeding), re-intervention and mortality. Hypothesis testing performed using Student’s t-test and Chi-Squared test.

Results:

This study included high-risk trauma cases with mean Injury Severity Score (ISS) of 30 (SD 11.3) {5}. Overall splenic salvage rate was 94%, with 4% splenectomy, and 2% mortality (86% non-splenic cause of death).

High-risk factors were not associated with increased complications: high grade splenic injury (83% of patients, p=0.07), unstable (25%, p=0.36), polytrauma (33.5%, p=0.61), and age >65 (10.4%, p=0.26). Embolization methods such as distal vs. proximal (p=0.69), coil vs. plug (p=0.33), and immediate vs. delayed (SAE >12 hours after trauma evaluation) (p=0.99) did not differ significantly.

Factors associated with increased adverse events and re-intervention include: gelfoam vs. plug/coil embolization (p < 0.001), extracapsular vs. intracapsular extravasation (p=0.005), and lack of collateral flow on post-embolization angiography (p < 0.001).

Conclusion:

In this retrospective study, we validate the safety and efficacy of SAE in NOM of high-risk patients, including unstable, polytraumatic, AAST Grade IV-V, and elderly patients. Splenic salvage rates match previously published data on HD stable and low ISS trauma {6, 7}. The reliability of SAE in high-acuity trauma remains robust to a variety of technical factors such as delayed intervention ( >12 hours, embolization material, and proximal vs. distal intervention.