What are the consequences of splenic infarction following embolization (embolization procedure)?

From the Guidelines

Splenic infarction after embolization should be managed with supportive care, including pain control and close monitoring for complications, as most patients can be managed conservatively and the condition often resolves spontaneously within weeks to months. The management of splenic infarction after embolization involves a multidisciplinary approach, considering the patient's overall clinical condition and the anatomical grade of injury. According to the guidelines for adult and pediatric patients with splenic trauma, patients with splenic infarction should be monitored for fever, worsening abdominal pain, or signs of infection, which could indicate abscess formation or other complications 1.

Key Considerations

• Patients should receive immunization against encapsulated bacteria, such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, at least 14 days after splenectomy or spleen total vascular exclusion 1.
• Annual immunization against seasonal flu is recommended for all patients over 6 months of age 1.
• Antibiotic therapy should be strongly considered in the event of any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible 1.
• Follow-up imaging with CT or ultrasound is recommended at 1-3 months to assess infarct evolution and splenic healing.

Complications and Management

• If complications such as abscess formation, persistent severe pain, or hemodynamic instability develop, more aggressive interventions including percutaneous drainage or splenectomy may be necessary.
• The development of splenic infarction after embolization is related to the intentional reduction of blood flow to portions of the spleen during the procedure, which is often performed for trauma, hypersplenism, or splenic artery aneurysms.
• Patients should be reassured that while uncomfortable, uncomplicated infarcts typically heal without long-term consequences.

Guidelines and Classification

• The WSES classification and guidelines for adult and pediatric patients with splenic trauma provide a framework for managing splenic infarction after embolization 1.
• The guidelines emphasize the importance of considering the patient's overall clinical condition, the anatomical grade of injury, and the presence of associated lesions when managing splenic trauma.

From the Research

Splenic Infarct after Embolization

• Splenic infarct is a potential complication of splenic artery embolization (SAE) 2, 3.
• A study published in the American Journal of Surgery in 2013 found that major complications, including splenic infarction, occurred in 14% of patients who underwent SAE 2.
• Another study published in the American Journal of Surgery in 2005 reported that major complications, including splenic infarction, occurred in 27% of patients who underwent SAE 3.
• The location of the embolization, either proximal or distal, may affect the risk of complications, with distal embolization associated with more major complications 2.
• However, another study found no relationship between the location of the embolization and the presence of complications 3.

Risk Factors and Clinical Outcomes

• The risk of splenic infarct after embolization may be related to the grade of splenic trauma and the patient's hemodynamic stability 4.
• A review of the literature on immune function after splenic artery embolization suggests that immune function may be preserved after SAE, unlike after splenectomy 5.
• A practice management guideline from the Eastern Association for the Surgery of Trauma recommends against routine post-splenectomy vaccinations in adult trauma patients who have undergone splenic angioembolization, citing evidence that embolization patients have fewer infectious complications and a greater degree of preserved splenic immune function 6.