9 - Failure of Initial Management and Delayed Pseudoaneurysm Formation in Splenic Trauma

Purpose: To identify variables associated with failure of initial management, including both operative and non-operative approaches, as well as delayed pseudoaneurysm formation in adults with splenic trauma.

Materials and Methods: A retrospective review of patients with traumatic splenic injury was performed using the UCMC Trauma Center Data Registry (2017–2024). An extensive chart review identified mechanisms of injury, initial management strategies, and grades of injury. The two primary outcomes were failure of initial management requiring re-intervention and delayed pseudoaneurysm formation. Inferential statistics were used to identify candidate predictors, which were further evaluated using univariate and multivariate logistic regression.

Results: 257 patients met the inclusion criteria, of which 159 (61.9%) sustained blunt trauma and 98 (38.1%) sustained penetrating trauma. Eighteen (7.0%) patients experienced failure of initial management and required unplanned intervention with interventional radiology or splenectomy. On multivariate logistic regression, both older age (OR 2.06, p = 0.003) and higher injury grade (OR 4.24, p = 0.007) were independently associated with increased odds of failure, with each age group increment ,(18-34, 35-49, 50-64, and 65+), doubling the odds and high-grade injuries, grade IV-V, conferring a four-fold risk compared to low- grade, grade I-III. Delayed pseudoaneurysm developed in 8 of 257 patients (3.1%) across all injury grades, including 6 of 62 patients (9.7%) with high-grade (grades IV–V) injuries. Seven were managed with embolization. Two were incidentally detected on angiography, while the remainder were identified on repeat CTA for suspected extravasation or pseudoaneurysm, with only one showing true extravasation on follow-up angiography. Initial management strategy (IR, non-operative, operative hemostasis, or splenectomy) was not associated with pseudoaneurysm formation (p = 0.607) while higher injury grade was independently predictive (OR 18.5, p = 0.008), with high-grade injuries nearly 18 times more likely to develop delayed pseudoaneurysm. Median time to pseudoaneurysm formation was 2.15 days, with two outliers at 8 and 12 days.

Conclusion: Higher-grade injury was associated with increased risk of failure of initial management and delayed pseudoaneurysm formation, independent of initial management. This study suggests that adopting a 2-week imaging follow-up protocol may help standardize surveillance for these complications and better define the role of interventional radiology in managing splenic trauma.