The ability to manage the majority of solid-organ injuries nonoperatively has become a cornerstone in the optimal approach to blunt trauma. Both diagnostic and therapeutic angiography is gaining increasing prominence as a technique by which this goal can be achieved.

The spleen is the most frequently injured organ following blunt abdominal trauma, with splenic injuries being present in 25% to 30% of cases. Liver injury is less frequent (15% to 20% of patients), and renal trauma is present in approximately 10% of patients. Although the circumstances in which angiography can be used in the management of these injuries are constantly evolving, a number of reports have demonstrated its value as an adjunct that can increase overall organ salvage and decrease the need for surgical intervention.

All grades of splenic injury have been successfully managed nonoperatively in hemodynamically stable patients. However, increasing grade of injury, as well as contrast extravasation or blush on admission computed tomography (which MUST be performed with intravenous contrast), has been associated with increasing likelihood of nonoperative management failure. Angioembolization has been considered useful in avoiding surgery in this subset of patients, who are most likely to fail observation in the intensive care unit. In recently published reports, between 5% and 15% of patients with splenic injuries were successfully managed with angioembolization, with success rates greater than 90% reported. The indications and technique for angioembolization in splenic trauma have been evolving rapidly and are the subject of considerable debate. Advocates of proximal splenic artery embolization theorize that this approach decreases splenic blood pressure, which prevents delayed hemorrhage and accelerates splenic healing while maintaining splenic perfusion through collateral blood flow. Others use angioembolization at the level of more distal arteries to the spleen, which requires more time and manipulation but preserves blood flow to the spleen.