Background: Splenic artery embolization is an interventional treatment used to stop active bleeding
in blunt splenic trauma. It is also commonly used as a prophylactic measure adjuvant
to other treatments in various clinical situations to promote splenic salvage and
non-operative management. The aim of this presentation is to give an overview of rationale
to indications, patient selection and procedural technicalities in splenic artery
embolization. Method(s): A thorough literature review was done on splenic artery embolization in blunt splenic
trauma as well as non-traumatic conditions. The content was reviewed for various indications,
the rationale for patient selection and use of this treatment as prophylactic or adjuvant
measures to medical treatment along with its long-term effect in non-operative management.
Experience of our institutional practice for this novel treatment was also added.
Result(s): Blunt splenic trauma American Association for the Surgery of Trauma Grade (AAST)
IV-V, is amongst most common indications for splenic artery embolization. Patient
selection in AAST Grade III splenic injury is variable depending on associated findings
(hemoperitoneum, active contrast blush, Pseudoaneurysm, fistula etc.), treating interventionist
and trauma unit. Other indications include portal hypertension, Idiopathic thrombocytopenic
purpura, Hypersplenism, thalassemia and splenic artery aneurysm with the risk of rupture.
Partial versus total embolization, proximal versus distal embolization and choice
of embolizing agents is variable amongst the treating interventionist depending on
the indication and aim of embolization. Splenic infarction with secondary infection/abscess
and non-targeted embolization are amongst the more severe, though less common complications.
Conclusion(s): Splenic artery embolization is a procedure to enhance the success rate of organ salvage
and non-operative management of blunt splenic trauma (AAST Grade III and above). It
is also a good adjuvant measure to improve the hepatic function and variceal bleeding
in portal hypertension as well as improve blood counts in various cytopenic conditions.
