Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

• Published in: Cardiovascular and interventional radiology 2015-10, Vol.38 (5), p.1143-1151
• Main Authors: Foley, P. T., Kavnoudias, H., Cameron, P. U., Czarnecki, C., Paul, E., Lyon, S. M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; ARTERIES; BLOOD; Cardiology; Clinical Investigation; COMPARATIVE EVALUATIONS; COMPUTERIZED TOMOGRAPHY; Embolization, Therapeutic - methods; Female; FUNCTIONS; Humans; Imaging; INJURIES; Male; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography; Nuclear Medicine; PATIENTS; PRESERVATION; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; SPLEEN; Spleen - diagnostic imaging; Spleen - immunology; Spleen - injuries; SPLENECTOMY; Splenic Artery - diagnostic imaging; Splenic Artery - immunology; Treatment Outcome; Ultrasound; WHO; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - immunology; Wounds, Nonpenetrating - therapy; Young Adult
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-015-1162-8

Purpose To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. Materials and Methods Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. Results Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. Conclusion IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.