Role and Techniques of Splenic Angioembolization in the Management of High-Grade (AAST III-V) Blunt Splenic Trauma: A Systematic Review

Blunt splenic trauma is the most common solid organ injury in abdominal trauma, with high-grade (American Association for the Surgery of Trauma (AAST) III-V) injuries carrying increased risk of hemorrhage and failure of non-operative management (NOM). Splenic artery embolization (SAE) has emerged as a key adjunct for hemodynamically stable patients, aiming to achieve hemostasis while preserving splenic function. This systematic review evaluated SAE outcomes in high-grade blunt splenic trauma, focusing on technical success, splenic salvage, re-bleeding, complications, delayed splenectomy, and mortality. Five retrospective cohort studies, including 600 adults, were analyzed. SAE demonstrated high technical success (92-100%) and splenic salvage rates (>90%). Proximal and distal embolization achieved comparable salvage rates; distal embolization was associated with longer fluoroscopy times and occasional re-bleeding, while combined techniques showed higher abscess formation. Overall mortality was low, and SAE facilitated preservation of splenic function, reducing the need for delayed splenectomy. Limitations include retrospective design, moderate-to-serious risk of bias, and limited long-term immunologic data. SAE is a safe and effective adjunct to NOM in high-grade blunt splenic trauma, with technique selection influencing complication profiles. Prospective studies are needed to optimize embolization strategies and evaluate long-term outcomes.