Prophylactic proximal splenic artery embolisation as an adjunct to conservative management of splenic injury. Is it necessary?

Abstract text (incl. references and figure legends)

Introduction
The management of splenic trauma is predominantly conservative, supplemented by interventional radiology (IR) where required. Many trauma centres advocate the use of proximal splenic artery embolisation (SAE) for prophylaxis of high-grade injury. The rational for this is that reducing inflow to and vascular pressure within the spleen reduces the risk of further splenic bleeding and failure of conservative management.

The purpose of this study was to evaluate the outcomes of high-grade splenic trauma at our London major trauma centre (MTC), specifically where proximal SAE for high grade splenic injury was not employed as an adjunct to conservative management.

Methods
We performed a retrospective review of a prospectively maintained database of all trauma patients presenting to our MTC between 2014 and 2021. All adult patients with either CT or operatively proven splenic injury were included. IR and follow up data was obtained from patient notes.

Results
337 patients with splenic trauma were included in this analysis. 309 patients presented following blunt trauma and 28 presented following penetrating trauma. 131 patients had grade III-V splenic injuries; 37/131 were managed with proximal SAE. Of these, 14/37 underwent intervention for active bleeding, 19/37 for extent of injury, 3/37 for pseudoaneurysm and 1/37 for arteriovenous fistula.

Of grade III-V patients not initially managed with proximal SAE, none required further interventional radiological or operative management.

Conclusions
Our data supports a targeted IR approach to the management of splenic trauma and does not support the use of prophylactic SAE for the management of high grade injury.

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