Do Technical Factors of Splenic Artery Embolization in Blunt Trauma Affect Major Complications Rate?

Presented During:

Wed, 4/1/2020: 3:09 PM  - 3:18 PM 
Washington State Convention Center  
Room: Room 201  

Final ID:

365 

Poster Type:

Scientific Session 

Authors:

O Kutsenko1, K Kobayashi1, J Assif1, M Jawed1

Institutions:

1SUNY Upstate Medical University, Syracuse, NY

First Author:

Oleksandra Kutsenko, MD  
SUNY Upstate Medical University
Syracuse, NY

Co-Author(s):

Katsuhiro Kobayashi, MD  
SUNY Upstate Medical University
Syracuse, NY
James Assif  
SUNY Upstate Medical University
Syracuse, NY
Mohammed Jawed, MD  
SUNY Upstate Medical University
Syracuse, NY

Presenting Author:

Oleksandra Kutsenko, MD  
SUNY Upstate University Hospital
Syracuse, NY

Purpose:

Previous studies demonstrated no difference in clinical success between different techniques or embolic agents used for splenic artery embolization (SAE). Given this, we sought to determine if technical aspects of SAE affect major complications in order to perform safer procedures.

Materials:

This is an IRB-exempt HIPPA compliant retrospective study. A total of 73 adult patients (F/M: 19/54, median age 49) with blunt trauma who underwent SAE between Oct 2011 and Aug 2019 were included in this study. We reviewed patients' medical records and imaging to identify major complications including splenic abscess, >50% infarction, and re-bleeding requiring splenectomy. The procedure technique included 39 proximal (to the origin of the first order branch of the splenic artery), 18 distal, and 16 combined embolizations. Materials used included coils 46 cases (63%), coils and Gelfoam 18 (25%), Gelfoam 5 (7%), Amplatzer plug with or without coils 4 (5%). Binary regression analysis was conducted to determine if technical factors affect major complications, allowing for splenic injury grade, laboratory values at presentation, transfusion requirement, CT evidence of active extravasation or pseudoaneurysms.

Results:

Among 73 patients, major complications occurred in 22 patients (30%) including >50% splenic infarction in 19 (26%), abscess in 3 (4%), and 4 delayed hemorrhages requiring splenectomy (5%). Binary regression analysis did not demonstrate any of the technical variables to influence major complications rate, including embolization location proximal (p=0.7, OR: 0.45-3.31), distal (p=0.13; OR: 0.14-1.3), combined (p=0.27; OR: 0.55-8.53) or embolic material used coil (p= 0.33; OR: 0.6-4.63), coil with Gelfoam (p=0.73; OR: 0.26-2.57), Gelfoam (p=0.16; OR: 0.04-1.67), Amplatzer plug (p=0.98; OR: <0.001-infinity), and Amplatzer with coil (p=0.99; OR: <0.001-infinity).

Conclusions:

Technique of embolization or embolic material used do not affect complication rate of the splenic artery embolization for blunt splenic trauma. This suggests that techniques and embolic material for SAE may be used according to operator's preference.

Abstract Categories:

Arterial Interventions: Embolization

Keywords:

Complications
Spleen trauma
Splenic Artery Embolization (SAE)