Impact of Splenic Artery Angioembolization on Conservative Management of Blunt Splenic Injury

Background: Splenic injury, the majority of frequent blunt abdominal trauma (32% of cases), can cause high mortality due to blood loss. In the early 1990s, splenectomy was the only treatment. This study aimed to evaluate the outcomes of conservative management for splenic injuries in adults, with the goal of refining current guidelines. Methods: A systematic review and meta-analysis were conducted at the General Surgery Department, Zagazig University, including randomized controlled trials and cohort studies up to 2024. Databases searched included PubMed, MEDLINE, Cochrane Library, and Google Scholar. Studies involving adult patients (>18 years) with BSI managed non-operatively were included. Data were extracted per PRISMA guidelines, and meta-analysis was performed using R-based software to calculate pooled prevalence, mean differences, and confidence intervals, assessing heterogeneity and risk of bias. Results: Fifty studies encompassing approximately 59,074 patients were analyzed. SAE demonstrated the lowest in-hospital mortality rate (4%) compared to operative management (11%) and observation-only NOM (6%). Clinical success was higher with SAE (78.3%) than with NOM (72.2%), whereas clinical failure was lowest in NOM (4.2%) and higher in SAE (12%) and operative groups (28%). Although SAE patients showed higher rates of pseudoaneurysm and active bleeding, these likely reflected selection of more severe cases. Hospital stay was shortest in NOM and longest in operative cases. Despite high heterogeneity, SAE consistently showed favorable survival and spleen-preservation outcomes. Conclusion: Non-operative management and SAE show lower mortality and higher success than operative management, which has more failures and longer hospital stays. High heterogeneity suggests study variability.