Splenic Artery Angioembolization is Associated with Increased Venous Thromboembolism
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ORIGINAL SCIENTIFIC REPORT
Splenic Artery Angioembolization is Associated with Increased Venous Thromboembolism M. Lewis1
•
A. Piccinini1 • E. Benjamin1 • D. Demetriades1
Accepted: 4 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Angioembolization has become an increasingly utilized adjunct for splenic preservation after trauma. Embolization of the splenic artery may produce a transient systemic hypercoagulable state. This study was designed to determine the risk of venous thromboembolism (VTE) in blunt trauma patients managed nonoperatively with splenic angioembolization, relative to those managed without. Method Retrospective review of the American College of Surgeons Trauma Quality Improvement Performance (TQIP) Database from 2013 to 2016. Adult ([16 years) patients with isolated, severe (Grades III–V) blunt splenic injuries managed nonoperatively who received pharmacological VTE prophylaxis formed the study population. Outcomes included deep venous thrombosis (DVT), pulmonary embolism (PE), or any VTE. Results A total of 2643 patients met inclusion criteria (69.1% Grade III, 26.5% Grade IV, 4.5% Grade V). The incidence of DVT was 4.5% in patients who underwent angioembolization, compared to 1.4% in patients who did not (p\0.001). Multivariable analysis showed that angioembolization was an independent risk factor for both DVT (OR 2.65, p = 0.006) and any VTE (OR 2.04, p = 0.01). Analysis according to splenic injury Grades showed that angioembolization remained an independent risk factor for DVT (p = 0.004) in the Grade IV-V injury group, and for VTE (p\0.01) in the Grade III injury group. Initiation of pharmacological VTE prophylaxis 48 h after admission was associated with increased VTE rates in comparison to early initiation (OR 1.75, p = 0.02) Conclusions Splenic artery angioembolization may be an independent risk factor for VTE events in isolated, severe blunt splenic trauma managed nonoperatively. Early prophylaxis with LMWH after intervention should be strongly considered.
Introduction The majority of blunt splenic injuries are managed nonoperatively [1]. Patients who undergo splenectomy are at risk for a variety of postoperative complications, including
& M. Lewis [email protected] 1
Division of Acute Care Surgery, Department of Surgery , University of Southern California Medical Center, Inpatient Tower, 2051 Marengo Street, Room C5L100, Los Angeles, CA 90033, USA
pancreatitis, pancreatic fistula, thromboses, gastric wall necrosis, typical postoperative infections, and overwhelming post-splenectomy infection (OPSI) [2]. Nonoperative management fails in 4–14% of cases [1], especially in higher Grade injuries or those with contrast extravasation noted on imaging [3]. Angioembolization has emerged as an adjunct with the potential to increase the success rate of nonoperative management [4]. Angioembolization usually involves the main splenic artery (proximal embolization) and occasionally segmental splenic artery branches (distal embolization) [5]. Occlusion of t
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