Splenic Artery Embolisation in Trauma: It is Time to Stand Alone as its Own Treatment
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LETTER TO EDITOR
Splenic Artery Embolisation in Trauma: It is Time to Stand Alone as its Own Treatment Warren Clements1,2
•
Heather K. Moriarty1,2
•
Jim Koukounaras1,2
Received: 25 June 2020 / Accepted: 4 July 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Dear Editor, Splenic artery embolisation (SAE) was first described in 1981 by Sclafani [1]. Since that time, it has been increasingly adopted into treatment algorithms for haemodynamically stable trauma patients. SAE offers the attractive possibility of splenic salvage compared with splenectomy [2]. Initial implementation of SAE was cautious, and designated the procedure an adjunct to non-operative management (NOM) [3, 4], a nomenclature reflecting the fact that trauma algorithms were traditionally managed by surgeons. NOM describes a combination of bed rest, serial examinations, monitoring of haemoglobin and haematocrit, and reduced oral intake [4]. Now, in many centres, the number of SAE being performed each year outweighs the number of splenectomies [5]. At our own centre, embolisation outnumbers splenectomy 10 to 1. There is now high-level evidence to support SAE as an efficacious procedure [5], coming a long way since its inception in 1981. In addition, trauma management is now a team approach of surgeons, intensivists, anaesthetists, interventional radiologists, and trauma physicians.
The authors believe that the available evidence and current structure of trauma care supports a change in mindset—that SAE should now stand on its own as a distinct treatment for blunt splenic injury, rather than being a procedure only considered as a NOM adjunct. A modern algorithm may allow patients to be treated under three distinct pathways depending on their clinical picture and imaging findings: splenectomy, SAE, or observation. In addition, it is no longer appropriate to compare embolisation to splenectomy as a gold standard, as this fails to address the loss of splenic function attributable to splenectomy [2]. SAE should be used in a multi-disciplinary environment where trauma clinicians including interventional radiologists communicate and make decisions as a team. It is time for a change of attitude and nomenclature in the modern literature to reflect that SAE is its own distinct procedure, rather than being constrained as a faceless non-operative adjunct.
Funding This study was not supported by any funding. Compliance with ethical standards
& Warren Clements [email protected] Heather K. Moriarty [email protected] Jim Koukounaras [email protected] 1
Department of Radiology, Alfred Hospital, Alfred Health 55 Commercial Road, Melbourne, VIC 3004, Australia
2
Department of Surgery, Monash University, Melbourne, Australia
Conflict of interest The authors declare that they have no conflict of interest. Informed consent For this type of study, consent was not required.
References 1. Sclafani SJ. The role of angiographic hemost
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