Is splenic artery embolization beneficial when splenic angiography is negative? A multicenter observational study

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BACKGROUND: While a positive splenic arteriography (SA) usually requires splenic artery embolization (SAE), the benefit of SAE after a negative SA is unclear. We hypothesized that SAE in patients with a negative SA would improve splenic salvage compared with no SAE. METHODS: A multicenter, retrospective, observational study was performed across 21 level 1 and 2 trauma centers from 2018 to 2023. Included were blunt trauma patients who underwent both computed tomography and SA. Patients arriving more than 48 hours after injury or without admission computed tomography were excluded. The primary endpoint was splenectomy within 30 days. SA was categorized as positive or negative based on prespecified criteria. Among patients with negative SA, those who underwent SAE were compared with those who did not. Cox proportional hazards and frailty models assessed the relative risk for splenectomy. RESULTS: Seven hundred twenty-six patients were included (median age, 44.5 y; median Injury Severity Score, 25). Of 332 with a negative SA, 80% underwent SAE. SAE was associated with lower splenectomy (5% vs. 16%, p =0.003) and mortality rates (2% vs. 10%, p =0.004). Adjusted Cox models showed reduced splenectomy risk with SAE when controlling for center splenectomy rate (HR, 0.33, 95% CI, 0.13-0.81, p =0.02) and urgent splenectomy rate (HR, 0.30, 95% CI, 0.13-0.65, p =0.005) but not when adjusting for SA utilization rate (HR, 0.69, 95% CI, 0.22-2.15, p =0.53) or including trauma center as a random effect (HR, 0.77, 95% CI, 0.27-2.30, p =0.65). Yet, complications requiring interventions after SAE (n=652) were not significantly different compared with those without SAE (n=74) (1.5% vs. 0%, p =0.34). CONCLUSIONS: In patients with negative SA, SAE was associated with reduced 30-splenectomy risk, but this association was not significant when including trauma center as a random effect. These findings suggest a possible association between SAE and splenic salvage in this selected cohort. ( J Trauma Acute Care Surg . 2026;101: 224-232. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

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