Maria Galindo Alins (Madrid / ES), Carlota Perez Carpio (Madrid / ES), Carlos Morales García (Madrid / ES), Laura Cebolla Rojas (Madrid / ES), Melanie Morote González (Madrid / ES), Cristina Rey Valcárcel (Madrid / ES), María Dolores Pérez Díaz (Madrid / ES), Fernando Turégano Fuentes (Madrid / ES)
Abstract text (incl. references and figure legends)
Introduction:
Spleen and liver are the most frequent injured solid organs in blunt abdominal trauma, almost 35-50% of patients presented injuries at these organs. Non operative management (NOM) is widely accepted in the management of these patient. In the last years angioembolization (AE) increased NOM indications through more complex injuries.The aim of this study is to analyze the efficacy and safety of AE and to identify risk factors associated with therapeutic failure.
Material and Methods:
Retrospective observational study based on a Level I Trauma Center prospective registry of severe trauma (1993-2022). We include all patients with hepatic and/or splenic injury who required an arteriography. We analyzed demographic data, trauma mechanism and patterns, injury severity, diagnostic and therapeutic management, and outcomes. Therapeutic failure was defined as the need of surgery or new embolization.
Results:
94 met inclusion criteria: 44 (47%) with liver injuries, 35 (37%) with splenic injuries and 15 (16%) with injuries in both. 49 (52%) required an AE (26 liver/23 spleen).Almost all patients had suffered a blunt trauma (92%). Median of Shock Index (SI) at admission was 0.85 (IQR 0.77) and mean RTS 10.6 (SD 2). ISS median was 26 (IQR 16) and the NISS 27 (IQR 17). In 45 patients EA was performed as part of NOM and in 4 cases was indicated after a damage control surgery. In 5 patients (10%) NOM failed. Risk factors associated were SI on arrival > 0.9, pathological abdominal examination on arrival and massive hemoperitoneum at the CT scan (p=0.017, p=0.046 and p=0.001.). 3 (6%) patients suffered AE related complications. In our sample 8 patients died, none of them due to therapeutic failure.
Conclusion:
AE allowed NOM in severe liver and spleen injuries, it's safe and effective. In our series, the therapeutic failure rate was 10%. Significantly associated to an IS>0,9, pathological abdominal findings on arrival and massive hemoperitoneum in the CT.
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