Experience with splenic main coil embolization and significance of new or persistent pseudoaneurym: Reembolize, operate, or observe

Background: To determine the need for further therapy in patients with persistent or new pseudoaneurysms (PSAs) after splenic main coil embolization. Methods: The institutional review board approved the study. The study group consisted of 400 hemodynamically stable patients (261 men, 139 women; mean age, 38.5 years) with blunt splenic injury. Abdominal computed tomography (ACT) images were assessed for grade of splenic injury, volume of hemoperitoneum, and evidence of splenic vascular injury including splenic vascular lesions and active bleeding. Splenic arteriography was performed for high-grade splenic injury and for ACT evidence of vascular injury. Follow-up ACT was reviewed for evidence of new or persistent PSAs after main coil embolization of the splenic artery. Medical records were reviewed to determine final outcome and any additional therapies used. Results: Thirty-two patients had persistent (27) or new PSAs (5) after main coil embolization. Of these patients, two required splenectomy and one splenorrhaphy. The nonoperative salvage rate was 91% and the splenic salvage rate was 94%; this was comparable to the overall salvage rate of 95%. Conclusion: Splenic embolization remains a valuable adjunct in splenic salvage. Patients with persistent or new splenic PSAs after main coil embolization have similar splenic salvage rates to the overall cohort without additional therapies.