Early Selective Angioembolization Improves Success of Nonoperative Management of Blunt Splenic Injury SHIH-CHI WU, M.D.,* KUAN-CHIH CHOW, PH.D.,† KUN-HUA LEE, M.D.,* CHENG-CHENG TUNG, M.D.,* ALBERT D. YANG, M.D.,‡ CHONG-JEH LO, M.D., F.A.C.S.§ From the *Division of Trauma and ‡Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan; †Graduate Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan; and §Department of Surgery, National Cheng-Kung University, College of Medicine, Tainan, Taiwan The role of angioembolization in the management of patients with blunt spleen injury is still under debate. Our study examined the impact of splenic artery embolization (SAE) on the out- come of such patients. We reviewed 114 consecutive blunt abdominal trauma patients with iso- lated splenic injury over a period of 40 months, including 61 patients seen before (Group A) and 53 patients seen after (Group B) the adoption of SAE. Hemodynamically unstable patients un- derwent the abdominal exploration and stable patients were evaluated with CT scans of abdomen and pelvis. Patients underwent SAE based on the findings of CT scans, including contrast ex- travasation or large hemoperitoneum. For initially stable patients, there were no differences in nonoperative management success rate between Groups A and B in regards to injury severity score ≥16, age, or grades of splenic injury ≥3. In comparison, among patients with large hemo- peritoneum found by abdominal CT, Group B had significantly better nonoperative management success rates (P < 0.05). SAE was successful to control bleeding in 80 per cent of patients. Partial splenic infarction was noted in all patients after the procedure but it resolved by six months. By using criteria developed based on abdominal CT scans for angioembolization, we are able to improve nonoperative splenic salvage rate. N ONOPERATIVE MANAGEMENT (NOM) of blunt splenic injury (BSI) in hemodynamically stable patients is widely accepted. 1–3 Operative procedures are only reserved for patients with hemorrhagic shock or with additional intra-abdominal injury requiring ex- ploration. Although these stable patients would un- dergo the abdominal CT to delineate the splenic in- jury, it remains unclear whether certain radiographic findings on CT, such as contrast blush, large amount of hemoperitoneum, or high grade of splenic injury would benefit from additional management including splenic artery embolization (SAE). Sclafani et al. 4 used selective splenic artery embolization for patients with contrast extravasation and found a higher success rate of nonoperative management of BSI. Similarly, Haan et al. 5 demonstrated a better splenic salvage rate with SAE in higher grades of splenic injury with to- mographic evidence of active bleeding. In contrast, Omert et al. 6 showed that contrast blush on CT scan merely related to higher grades of splenic injury and therefore it was not, by itself, an absolute indication for an operative procedure. SAE is an effective alter- native or adjunct for hemostasis after splenic injury and may play an important role in the nonoperative management of splenic injury. 5, 7, 8 Intuitively, SAE should be performed as soon as contrast extravasation is discovered and before the deterioration of hemody- namics occurs. However, it remains controversial whether the patient who has the splenic injury, delin- eated by CT scanning, but becomes hemodynamically unstable could undergo SAE. 9, 10 In addition, because contrast blush is frequently detected during a repeated CT scanning, 10 the role of routine follow-up radio- graphic evaluations deserves further investigation even in a stable patient with no clinical indications. In this study, we investigated whether SAE was effective and safe in the management of BSI and how this intervention would affect the outcome. We also discussed factors that influence the success rates of NOM. Address correspondence and reprint requests to Chong-Jeh Lo, M.D., F.A.C.S., Associate Professor, Department of Surgery, Na- tional Cheng-Kung University, College of Medicine, 138 Sheng-Li Road, Tainan, Taiwan. E-mail: jehlo@mail.ncku.edu.tw. 897