Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial

Ben L. Zarzaur, Julie A. Dunn, Brian Leininger, Margaret Lauerman, Kathirkamanthan Shanmuganathan, Krista Kaups, Kirellos Zamary, Jennifer L. Hartwell, Ankur Bhakta, John Myers, Stephanie Gordy, Samuel R. Todd, Jeffrey A. Claridge, Erik Teicher, Jason Sperry, Alicia Privette, Ahmed Allawi, Clay Cothren Burlew, Adrian A. Maung, Kimberly A. DavisThomas Cogbill, Stephanie Bonne, David H. Livingston, Raul Coimbra, Rosemary A. Kozar

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

BACKGROUND Following blunt splenic injury, there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with pseudoaneurysm or blush. METHODS Data were collected on adult (aged ≥18 years) patients with blunt splenic injury and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy. RESULTS Two hundred patients with a vascular abnormality on computed tomography scan were enrolled. Of those, 14.5% were managed with early splenectomy. Of the remaining patients, 59% underwent angiography and embolization (ANGIO), and 26.5% were observed. Of those who underwent ANGIO, 5.9% had a repeat ANGIO, and 6.8% had splenectomy. Of those observed, 9.4% had a delayed ANGIO, and 7.6% underwent splenectomy. There were no statistically significant differences between those observed and those who underwent ANGIO. There were 111 computed tomography scans with splenic vascular injuries available for review by an expert trauma radiologist. The concordance between the original classification of the type of vascular abnormality and the expert radiologist's interpretation was 56.3%. Based on expert review, the presence of an actively bleeding vascular injury was associated with a 40.9% risk of splenectomy. This was significantly higher than those with a nonbleeding vascular injury. CONCLUSIONS In this series, the vast majority of patients are managed with ANGIO and usually embolization, whereas splenectomy remains a rare event. However, patients with a bleeding vascular injury of the spleen are at high risk of nonoperative failure, no matter the strategy used for management. This group may warrant closer observation or an alternative management strategy. LEVEL OF EVIDENCE Prognostic study, level III.

Original languageEnglish (US)
Pages (from-to)999-1005
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number6
DOIs
StatePublished - Dec 1 2017

Keywords

  • Blunt spleen injury
  • spleen blush
  • spleen pseuodoaneurysm
  • spleen vascular injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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