TY - JOUR
T1 - Natural history of splenic vascular abnormalities after blunt injury
T2 - A Western Trauma Association multicenter trial
AU - Zarzaur, Ben L.
AU - Dunn, Julie A.
AU - Leininger, Brian
AU - Lauerman, Margaret
AU - Shanmuganathan, Kathirkamanthan
AU - Kaups, Krista
AU - Zamary, Kirellos
AU - Hartwell, Jennifer L.
AU - Bhakta, Ankur
AU - Myers, John
AU - Gordy, Stephanie
AU - Todd, Samuel R.
AU - Claridge, Jeffrey A.
AU - Teicher, Erik
AU - Sperry, Jason
AU - Privette, Alicia
AU - Allawi, Ahmed
AU - Burlew, Clay Cothren
AU - Maung, Adrian A.
AU - Davis, Kimberly A.
AU - Cogbill, Thomas
AU - Bonne, Stephanie
AU - Livingston, David H.
AU - Coimbra, Raul
AU - Kozar, Rosemary A.
N1 - Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - 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.
AB - 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.
KW - Blunt spleen injury
KW - spleen blush
KW - spleen pseuodoaneurysm
KW - spleen vascular injury
UR - https://www.scopus.com/pages/publications/85020232211
U2 - 10.1097/TA.0000000000001597
DO - 10.1097/TA.0000000000001597
M3 - Article
C2 - 28570347
AN - SCOPUS:85020232211
SN - 2163-0755
VL - 83
SP - 999
EP - 1005
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 6
ER -