• Po Ping Liu, Wei Che Lee, Yu Fan Cheng, Pei Min Hsieh, Yu Min Hsieh, Bool Lee Tan, Feng Chi Chen, Tai Chien Huang, and Cheng-Cheng Tung.
• Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. poping@ms9.hinet.net
• J Trauma. 2004 Apr 1;56(4):768-72; discussion 773.

BackgroundSplenic artery embolization (SAE) has been used as an adjunct to the nonsurgical treatment of blunt splenic injuries since 1981. It is imperative to define the role of SAE in the management of splenic trauma and to establish a guideline for its use.MethodsIn this study, 39 consecutive patients with blunt splenic ruptures were evaluated. All the patients were treated according to the authors' protocol, which included SAE as an adjunct. Angiographic study was performed for patients with any of the following presentations: recurrent hypotension despite fluid resuscitation, significant hemoperitoneum or extravasation of contrast media on computed tomography, grade 4 or 5 splenic injury, or progressive need for blood transfusion. Laparotomy was reserved for patients with unstable hemodynamics or failure of SAE.ResultsFour patients were excluded from the study, and 6 of the 35 remaining patients (male-to-female ratio, 22:13) received SAE. One of the six SAE patients underwent operation because of persistent hemorrhage after SAE. Nonoperative treatment was successful for 31 patients. Splenic artery embolization increased the success rate for nonsurgical management from 74% (26 of 35 patients) to 89% (31 of 35 patients).ConclusionsJudicious use of SAE for patients with blunt splenic injury avoids unnecessary surgery and expands the number of patients who can retain their spleen.

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