Brown Patrick, Lokuhetty Naradha, Kakridas Panagiota, Clements Warren, Lukies Matthew
Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
Trauma Service, The Alfred Hospital, Melbourne, VIC, 3004, Australia.
Cardiovasc Intervent Radiol. 2025 Aug 6. doi: 10.1007/s00270-025-04138-z.
Splenic artery embolisation (SAE) is a well-established treatment for high-grade splenic laceration due to blunt trauma in haemodynamically stable patients supported by major societal guidelines. However, guidelines support splenectomy in unstable patients, and there are limited data assessing the efficacy and role of SAE in this cohort. This study aimed to analyse the efficacy of splenic artery embolisation for unstable trauma patients in preventing mortality.
A single-centre retrospective case-control study was performed covering a 13.5-year period. Patients with splenic laceration due to blunt trauma who underwent splenic artery embolisation or splenectomy were identified and analysed. Haemodynamically unstable patients, as defined by a shock index of ≥ 1.0 or systolic blood pressure of < 90 mmHg, who underwent SAE versus upfront splenectomy were compared as specific cohorts. The primary outcomes were all-cause 30-day mortality and splenic salvage rates.
A total of 126 haemodynamically unstable patients underwent SAE for blunt trauma, and eight haemodynamically unstable patients underwent upfront splenectomy. Among unstable patients who underwent SAE, splenic salvage was achieved in 98%, with 4% mortality at 30 days. Comparing unstable patients who underwent SAE versus upfront splenectomy, there was no significant difference in mortality at 30 days (p = 0.34).
Splenic artery embolisation is a safe and efficacious treatment in unstable patients with splenic laceration due to blunt trauma, with no significant difference in mortality compared to upfront splenectomy, supporting SAE as a primary treatment standard in this patient cohort.
脾动脉栓塞术（SAE）是一种公认的治疗方法，用于治疗血流动力学稳定的患者因钝性创伤导致的高级别脾裂伤，这得到了主要社会指南的支持。然而，指南支持对不稳定患者进行脾切除术，并且评估SAE在该队列中的疗效和作用的数据有限。本研究旨在分析脾动脉栓塞术对不稳定创伤患者预防死亡的疗效。
进行了一项单中心回顾性病例对照研究，涵盖13.5年的时间。确定并分析因钝性创伤导致脾裂伤并接受脾动脉栓塞术或脾切除术的患者。将休克指数≥1.0或收缩压<90 mmHg定义为血流动力学不稳定的患者，比较接受SAE与直接脾切除术的特定队列。主要结局是全因30天死亡率和脾挽救率。
共有126例血流动力学不稳定的患者因钝性创伤接受了SAE，8例血流动力学不稳定的患者接受了直接脾切除术。在接受SAE的不稳定患者中，98%实现了脾挽救，30天死亡率为4%。比较接受SAE与直接脾切除术的不稳定患者，30天死亡率无显著差异（p = 0.34）。
脾动脉栓塞术是治疗因钝性创伤导致脾裂伤的不稳定患者的一种安全有效的方法，与直接脾切除术相比，死亡率无显著差异，支持SAE作为该患者队列的主要治疗标准。
