• J Haan, J Scott, R L Boyd-Kranis, S Ho, M Kramer, and T M Scalea.
• Department of Surgery, University of Maryland School of Medicine, Baltimore, USA. jhaan@trauma.ummc.umaryland.edu
• J Trauma. 2001 Dec 1;51(6):1161-5.

BackgroundTo analyze the use of admission angiography as a nonoperative adjunct for management of blunt splenic injury.MethodsRetrospective chart review of all blunt splenic injuries to a Level I trauma center from March 1997 through July 1999.ResultsOne hundred twenty-six patients underwent angiography for splenic injury. Eighty-six patients (68%) had a negative angiogram and were treated expectantly. Of these, seven patients (8%) required laparotomy, with a splenic salvage rate of 92%. Embolization was performed on 40 patients (32%) for evidence of vascular injury. Of these, three patients (8%) required laparotomy, for a total salvage of 92%. Repeat angiography was performed for suspicion of bleeding in 12 patients (10%), with 50% requiring embolization. Outcome based on CT grade demonstrated an average grade of 2.9, with a salvage rate of greater than 70% for grade IV and V injuries.ConclusionVascular injury increases with splenic injury grade. Embolization improves nonoperative salvage rates to 92%, even with high-grade injuries. Ten percent of patients require additional therapy including "second-look" angiography. A significant portion of patients with negative screening angiograms (10%) required either embolization or laparotomy to control delayed hemorrhage.

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