Interventional Radiology in Splenic Trauma: If Not Now Then When

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Interventional Radiology in Splenic Trauma: If Not Now Then When

Dana Paula Venter, Mircea Beuran, Laurenţiu Gulie, Monica Popiel, Mircea Dan Venter, Constantin Oprescu, Costin Minoiu, George Pană, Bogdan Popa, Georgian Tiberiu Tănase
Original article, no. 6, 2021
Article DOI: 10.21614/chirurgia.116.6.700
Introduction: The treatment of blunt splenic injuries showed major evolutionary changes, from fundamental/ basic splenectomy to nonoperative and endovascular treatment, "catheter surgery". Currently, in Trauma Centers, splenic angioembolization is considered the first-line intervention in trauma. This article presents the Bucharest Emergency Clinical Hospital experience in the use of splenic angioembolization, a therapeutic solution in accordance with contemporary practice and literature.

Methods: This retrospective study includes patients with splenic trauma by blunt mechanism, in which diagnostic / therapeutic angiography was performed, hospitalized in the Clinical Emergency Hospital Bucharest between January 2006 and December 2019. The main endpoints of the study were: post-traumatic mortality, the need for surgery (laparoscopic/classic) to resolve splenic bleeding, the number of days of hospitalization, the need for hospitalization for more than 1 day in the intensive care unit, the day when the platelet count began to increase, the evolution of laboratory parameters (hospitalization, preangiography, postangiography/embolization, discharge). A secondary endpoint of the study was the frequency of complications that did not require surgery.

Results: During the mentioned period in 64 patients treated nonoperatively, diagnostic angiography was performed (27 cases, group B) or therapeutic angiography (37 cases, group A). 26.56% of cases were 55 years old (55-81 years old), the predominance of males being obvious (62.5%). The mean value of the ISS was 21.7 +- 10.4, and 71.87% of cases presented ISS 16. The mean value of the ISS was 21.7 +- 10.4, and 71.87% of cases presented ISS 16. The degree of splenic injury (American Association for the Surgery of Trauma-Organ Injury Scale) presented the mean value 2.95. The degree of splenic lesion was statistically significantly more severe in group A (p 0.001) and preangiography hemoglobin values were significantly lower compared to hospitalization values (p 0.001) indicating the persistence of hemorrhage. Procedural failures occurred in 4.68% of cases, with zero mortality.

Conclusions: Splenic interventional radiology is a safe, effective and rational procedure. The development of therapeutic protocols is necessary to allow maximum use of this procedure.

Keywords: nonoperative treatment, interventional radiology, blunt splenic injury