Splenic Artery Embolization: Tips, Tricks, and Current Standards of Practice.

The spleen is a vital intra-abdominal organ that provides a role in hematopoietic and immunologic functions. It is highly vascular and is the most commonly injured organ in the setting of blunt trauma, potentially leading to life-threatening hemoperitoneum. Splenic artery embolization (SAE) serves as an alternative to operative management of patients with splenic trauma and has quickly become popular given the infectious risks associated with splenectomy. Since its inception, indications for SAE have evolved beyond the management of traumatic injury. The authors discuss splenic artery anatomy and the importance of maintaining critical collateral pathways when SAE is performed to preserve splenic and distal pancreatic arterial flow and minimize complication risks. An in-depth and evidence-based review of SAE in the setting of trauma is provided, including a comparison between proximal and distal embolization techniques. Nontraumatic indications for splenic embolization to induce splenic involution are covered, including for the treatment of hypersplenism, thrombocytopenia, portal hypertension, and complications of liver transplant such as the small-for-size syndrome and splenic artery steal syndrome. The use of SAE for the treatment of splenic aneurysms and upper gastrointestinal bleeding is also discussed. Periprocedural and intraprocedural technical considerations are covered, such as the routes of vascular access, type of embolic used, role of vaccination, preprocedural imaging, antibiotic therapy, and postprocedural management and complications. ©RSNA, 2026 Supplemental material is available for this article. See the invited commentary by Montgomery and Elliott in this issue.