Selective Angioembolization in Blunt Solid Organ Injury in Children and Adolescents: Review of Recent Literature and Own Experiences

Nonoperative management (NOM) is considered the standard therapy for clinically stable children with blunt solid organ injuries (SOI) grade I to IV. The capability of angioembolization (AE) to decrease the NOM failure rate in adults with blunt SOI has been demonstrated. The inclusion of AE in the pediatric SOI management is rarely reported. The aim of this review is to evaluate the recent literature surrounding trauma-related AE in children focusing on criteria for patient selection for AE and on the success rates including the greater experience in adults and on our own little series with splenic and renal injuries at a Level 1 Trauma Center. The technique will be described in detail. Although already added to some institutional treatment protocols patient selection for AE is still without full consent. High-grade injury, active bleeding with contrast blush on computed tomography, threatening, or ongoing hemodynamic instability and pseudoaneurysm represent the most common criteria to admit AE. Patients' characteristics are often similar to those of NOM failure groups in trauma managements protocols without AE. The impact of this interventional approach is situated between the possibility for NOM in the obvious stable child and the need for open surgery in the obvious unstable patient with grade IV to grade V SOI. There is evidence that AE is capable to decrease the failure rate and complications in the NOM. Although available data are based on cohort studies rather than prospective randomized-controlled trials, we conclude, AE represents a safe and effective therapy and should be part of the interdisciplinary trauma management protocol for SOI in children and adolescents.