++
The incidence of solid organ injury after trauma varies significantly in the literature, depending on the mechanism and the solid organ of interest. The liver remains one of the most commonly injured organs after blunt abdominal trauma, followed closely by the spleen.1,2 Over time, management of solid organ injury has shifted from operative to nonoperative management (NOM) in select cases, leading to decreased morbidity and high rates of success. Angioembolization (AE) techniques were introduced with the aim of preventing ongoing hemorrhage requiring surgery and are often used to supplant NOM. However, the key to success in each case is appropriate patient selection.
++
In the ensuing sections, the use of solid organ embolization for the management of traumatic injury will be discussed as it pertains to solid organs, including the liver, spleen, kidney, lung, and pancreas. Additional areas covered will include endovascular methods available for hemorrhage control for solid organ injury, when to opt for open surgery or NOM, and pearls and pitfalls associated with an endovascular approach. It is crucial to know when to select each approach, as any delays to hemorrhage control increase morbidity and mortality.3
+++
DEFINITION OF SOLID ORGANS FOR THIS CHAPTER
+++
Liver, Kidney, Spleen
++
The liver and spleen are the two solid organs that most often undergo AE due to the fact that they are the most commonly injured organs after blunt trauma. The liver is the largest solid organ in the peritoneal cavity, which makes it particularly prone to injury. On the contrary, despite its small size the spleen is the most frequently injured solid organ that results in laparotomy. However, the introduction of AE has increased splenic salvage rates.4
++
The kidney is well protected due to its retroperitoneal location, and the overlying Gerota’s fascia adds extra protection against the forces of blunt trauma. Renal injuries occur in <5% of all trauma patients and approximately 90% are due to a blunt versus penetrating mechanism.5
++
The majority of injuries undergo NOM. A penetrating mechanism is more likely to result in major vascular injury mandating operative intervention. AE is less commonly used for renal injury as most injuries are of low grade and will likely heal with NOM.6
++
Due to its retroperitoneal location, the pancreas is generally well protected and unlikely to result in injury caused by a blunt mechanism. The overall incidence of pancreatic trauma is reported to be anywhere from 2% to 12% and more likely is due to a penetrating mechanism.7 The high morbidity associated with pancreatic trauma is due to the fact that it is rarely injured in isolation; several other organs including the duodenum surrounding vascular structures, and the spleen and kidney are often injured as well.8
+...