Preoperative embolization of the splenic artery in patients that underwent splenectomy for immune thrombocytopenic purpura

Abstract

Transfusion of platelets, red blood cells, or both is usually necessary immediately after splenic artery ligature in patients with immune thrombocytopenic purpura who undergo splenectomy. Purpose: To investigate whether preoperative embolization of the splenic artery reduced the need for transfusion of platelets, red blood cells, or both. Methods: Twentyseven consecutive patients that underwent splenectomy for purpura between October 1999 and March 2006 performed by the same surgical team were enrolled. The fi rst 17 patients did not undergo embolization and were compared with the next 10 patients, who composed the embolization group. Results: The platelet count in the embolization group rose from a mean 7000 u/μl before to 75000 u/μl after the procedure. There was no need for platelet or red blood cell transfusion in the embolization group; in the group without preoperative embolization, 11 patients (p=0.001) required platelet transfusion and 8 (p=0.01), red blood cell transfusion. Conclusion: Embolization of the splenic artery before splenectomy is a safe method to avoid blood transfusions in patients with ITP. Key words: Purpura Thrombocytopenic, Idiopathic. Embolization, Therapeutic. Splenectomy. RESUMOA transfusão de plaquetas e ou hemácias geralmente é realizada em pacientes submetidos a esplenectomia por Purpura Trombocitopênia Imune (PTI). Objetivo: Investigar se a embolização pré-operatória da artéria esplênica é efi caz na redução da necessidade de transfusão de hemácias ou plaquetas. Métodos: Vinte e sete pacientes foram submetidos a esplenectomia por PTI de Outubro de 1999 a Março de 2006 pela mesma equipe cirúrgica. Os primeiros 17 pacientes não foram submetidos a embolização e foram comparados com os outros 10 individuos nos quais a embolização foi realizada. Resultados: A contagem de plaquetas no grupo em que a embolização foi realizada subiu de uma média de 7000u/μl antes do procedimento, para 75000 u/μl após. Não foi necessário transfundir plaquetas ou glóbulos vermelhos no grupo submetido a embolização comparado com 11 pacientes com transfusão de plaquetas (p=0,001) e 8 pacientes com transfusão de hemácias (p=0,01) no grupo sem embolização pré-operatória .Conclusão: A embolização pré-operatória da artéria esplênica é um método seguro e efi caz para evitar o uso de transfusões em esplenectomias por PTI.

Splenectomy for hypersplenism with or without preoperative splenic artery embolisation

“…The value of preoperative SAE observed in our study for a better control of intraoperative blood loss during splenectomy confirms the results of previously published studies in the management of patients with hypersplenism [ 10 , 11 ], as there was no need for blood transfusion in the SAE patient group. In 2007, Bau et al [ 10 ] reported on a patient series without preoperative SAE. They had severe haemorrhagic complications that required transfusions of platelets in 65% of cases and of red blood cells in 47%, while there was no need for blood transfusion in their preoperative SAE group.…”

“…In our study, there was an overall improvement in the platelet count after embolisation in the SAE patient group (mean 380,000 U/ μL, on day 10 post surgery). This finding provides a better evidence on the effect of the SAE and confirms other many older series [ 5 , 10 , 11 , 21 ]. SAE leads to a softer and smaller spleen, improves the surgical view and reduces the incidence of bleeding [ 11 , 22 ].…”

“…Preoperative SAE makes splenectomy a safer procedure by reducing the intraoperative blood loss and the need for blood transfusion [ 9 ]. SAE before splenectomy improves the platelet count, reduces the size of the spleen and makes it softer [ 10 , 11 ].…”

Haematological and biochemical characteristics of the splenic effluent blood in schistosomal patients undergoing splenectomy

“…The splenic artery ligation in early splenectomy allows the output of blood by the spleen splenic vein and reduces the size of the spleen due to the inflow of splenic blood into the portal circulation [22][23][24][25] . According to the literature during the removal of larger spleens there is inflow of more than 500 ml of whole blood 1 .…”

Splenic artery embolization: An alternative approach in a critically ill patient with autoimmune hemolytic anemia

“…Preoperative splenic artery embolization has been suggested as a potential way to reduce this complication [7]. Embolization can decrease the need for transfusion in patients with immune thrombocytopenic purpura when performed prior to splenectomy [8]. Contrast-induced nephropathy is a potential adverse outcome of the embolization procedure, particularly in patients with such risk factors as chronic renal disease, diabetes mellitus, advancing age, congestive heart failure, hypotension, and shock.…”