SIR 2024
Embolization
Christina Dalzell, MD
IR Resident
University of Virginia
Financial relationships: Full list of relationships is listed on the CME information page.
John F. Angle, MD
Professor
University of Virginia
Financial relationships: Full list of relationships is listed on the CME information page.
Luke R. Wilkins, MD, FSIR
Associate Professor
University of Virginia
Financial relationships: Full list of relationships is listed on the CME information page.
Following blunt trauma, contrast extravasation (CE) from the spleen on computed tomography (CT) imaging is associated with increased morbidity and mortality. The current study sought to determine the relationship of CE on CT with active arterial bleeding on splenic angiography and associated clinical outcomes.
Materials and Methods:
Single center retrospective review from January 6, 2012, to September 13, 2023, of 196 consecutive patients who underwent splenic angiography secondary to blunt trauma at a level 1 trauma center. Contrast enhanced CT was performed prior to angiography in all patients. Clinical, imaging, and procedural data were recorded. American Association for the Surgery of Trauma (AAST) splenic injury grade was determined by two independent readers.
Results:
Of the 196 patients, 56% (110/196) had CE on CT. Of those with CE on CT, 27% (30/110) had CE on subsequent angiography. CE on CT was associated with a 5-fold increase in the odds of CE on angiography (OR: 5, 95% CI: 2.0-12.4; p < 0.001). There was no statistically significant association between AAST grade and CE on angiography. The sensitivity, specificity, positive predictive value, and negative predictive value of CE on CT for CE on angiography was 83%, 50%, 27%, and 93% respectively. The sensitivity, specificity, PPV, and NPV of an AAST grade of 4 or 5 for CE on angiography was 83%, 14%, 18%, and 79% respectively. Patients with CE on splenic angiography were older in age (52.9 ± 20.4 versus 44.1 ± 19.2 years, p = 0.01). Time from CT to angiography was increased in patients without CE on angiography (235.7 ± 132.3 versus 172.5 ± 84.4 minutes, p = 0.01). All patients with CE on CT underwent splenic artery embolization. There was no difference in need for post-procedural blood transfusion, repeat angiography, or splenectomy between those with and without CE on angiography. However, patients with CE on angiography had significantly higher 30-day mortality versus those without CE (5/36, 13.9% versus 2/160, 1.25%, p = 0.003). AAST grade was not associated with 30-day mortality or need for post-procedural blood transfusion.
Conclusion:
CE on CT has a low positive predictive value for CE on angiography but performs better than AAST grade. After a positive CT, the time to angiography predicts the likelihood of a positive angiogram. There was increased 30-day mortality in patients with active CE on angiography.