ANGIO-EMBOLIZATION IN BLEEDING BLUNT SPLENIC INJURIES: IT WORKS BUT LOOK OUT CONSEQUENCES

Introduction: Non operative management (NOM) of blunt splenic injuries has been widely accepted, and the splenic angio-embolization (SAE) has been more and more becoming an effective tool in haemodynamically stable patients with all AAST grade splenic injuries. Overall complication rate of SAE is 6-8 %. Aim of this study was to analyze complications that may occur after SAE Material and methods: We reviewed 24 consecutive patients with blunt splenic trauma admitted to our Unit who underwent SAE. All these patients were managed in according to a diagnostical-therapeutic algorithm taken from international guidelines. Indications for SAE included evidence of spleen contrast extravasation/blush, pseudoaneurysm and/or AAST grade III-V splenic injury. SAE included 15 distal, 3 proximal and 6 combined arterial embolizations. The complications occured after SAE procedure have been analysed Results: Major complications occurred in 5 SAE-treated patients (20.8 %). 4 patients developed post-procedure bleeding and underwent early splenectomy. One patient developed an abscess in a total infarcted spleen and underwent late splenectomy. Minor complications, not requiring a surgical operation, occurred in 24 % patients and included fever and pleural effusion with an average hospital stay meanly longer than 7 days. Conclusion: Major and minor SAE complications could jeopardize the conservative management of blunt spleen injuries. A strict clinical and radiological follow up must be taken into account after a SAE procedure. SAE major complication rate could be considered acceptable for the effectiveness of the procedure, but it is likely that the other minor ones could be related to an increased cost of hospitalization and a longer mean hospital stay.