1. Do trauma patients need post-splenectomy prophylaxis after splenic artery embolization?
D. van Embden

2. Background
Splenic artery embolization for splenic injury
Is immune function of the spleen preserved?
S. pneumoniae (70%), H. influenzae B, N. Meningitides
OPSI = 70% fatal (2–5 per 1000)

3. Practice at RLH ?

4. PICO Question
Population: children/adults with splenic trauma in need for intervention
Intervention: vaccinations and/or antibiotic prophylaxis
Comparator: no vaccination/AB prophylaxis
Outcome: number post-splenectomy infection
No studies

5. Results
MeSH Terms: wounds and injuries; embolization, therapeutic; splenic artery; physiology
Results: 37
CT: 2 (1)
Review: 7 (1)
Other: 3 (Inc refs)
Pirasteh A et al. Temporal assessment of splenic function in patients who have undergone percutaneous image-guided splenic artery embolization in the setting of trauma. J Vasc Interv Radiol Jan;23(1):80-2. (RCT)
Schimmer JA et al. Splenic function after angioembolization for splenic trauma in children and adults: A systematic review. Injury Mar;47(3): (SYST REVIEW)
Malhotra AK et al. Preservation of splenic immunocompetence after splenic artery angioembolization for blunt splenic injury. J Trauma Nov;69(5): ;
Skattum J et al. Preserved splenic function after angioembolisation of high grade injury. Injury Jan;43(1):62-6. Epub 2010 Jul 31.
Bessoud B, Duchosal MA, Siegrist CA, Schlegel S, Doenz F, Calmes JM, Qanadli SD, Schnyder P, Denys A. Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up. J Trauma Jun;62(6):

6. So what?
Pirasteh A et al. (CT): No loss of phagocytic function of the spleen in patients who have undergone SAE
Malhotra AK et al (CC): Splenic immune function, measured by T-cell subset, generated only in the presence of an immunocompetent spleen, is preserved after SAE for BSI, main or partial.
Skattum J et al (CC): Normal levels of IG and mB cells, absence of H-J bodies and preserved splenic size and blood flow suggest that SAE has only minor impact on splenic function and that immunisation probably is unnecessary.
Bessoud B et al. (RETRO) Proximal splenic artery embolization in blunt splenic injuries is a well-tolerated technique without major long-term impact on the splenic anatomy and immune function.
Schimmer JA et al. (SYST REVIEW): In all but one studies on the long term effects of SAE indicate a preserved splenic function.

7. So what? Schimmer JA et al 2016:
12 studies (1 paediatric) used different parameters (Howell–Jolly body/ CD4 etc)
11 studies found a preserved splenic function
0 studies: AB for infection
OPSI after SAE is not mentioned
Despite of lacking hard evidence there is a trend not to vaccinate patients who had SAE:
Survey: 261 trauma surgeons (US)
After splenectomy 99.2% vaccinations
After SAE only 8.4%
overwhelming postsplenectomy infection

8. No vaccination or prophylaxis after SAE
So what?
No hard evidence
No vaccination or prophylaxis after SAE
overwhelming postsplenectomy infection