Adverse Events Related to Partial Splenic Embolization for the Treatment of Hypersplenism: A Systematic Review

Talwar, Abhinav; Gabr, Ahmed; Riaz, Ahsun; Desai, Kush; Thornburg, Bartley; Mouli, S.; Lewandowski, Robert J.; Salem, Riad

doi:10.1016/j.jvir.2019.08.015

Cited by 26 publications

(31 citation statements)

References 53 publications

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“…The ability to reliably assess splenic vascular flow may aid the clinical workup of hypersplenism 33 or serve a role in identification of candidates for partial splenic embolization 34,35 . A previously reported 4D flow‐based metric termed the splenic flow index was reported to be superior to splenic volume and simple blood flow measures in predicting the serological derangements of cirrhosis‐associated hypersplenism 36 .…”

Section: Discussionmentioning

confidence: 99%

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Brunsing

Brown

Almahoud

et al. 2021

Magnetic Resonance Imaging

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Background Non‐invasive assessment of the hemodynamic changes of cirrhosis might help guide management of patients with liver disease but are currently limited. Purpose To determine whether free‐breathing 4D flow MRI can be used to quantify the hemodynamic effects of cirrhosis and introduce hydraulic circuit indexes of severity. Study Type Retrospective. Population Forty‐seven patients including 26 with cirrhosis. Field Strength/Sequence 3 T/free‐breathing 4D flow MRI with soft gating and golden‐angle view ordering. Assessment Measurements of the supra‐celiac abdominal aorta, supra‐renal abdominal aorta (SRA), celiac trunk (CeT), superior mesenteric artery (SMA), splenic artery (SpA), common hepatic artery (CHA), portal vein (PV), and supra‐renal inferior vena cava (IVC) were made by two radiologists. Measures of hepatic vascular resistance (hepatic arterial relative resistance [HARR]; portal resistive index [PRI]) were proposed and calculated. Statistical Analysis Bland–Altman, Pearson's correlation, Tukey's multiple comparison, and Cohen's kappa. P < 0.05 was considered significant. Results Forty‐four of 47 studies yielded adequate image quality for flow quantification (94%). Arterial structures showed high inter‐reader concordance (range; ρ = 0.948–0.987) and the IVC (ρ = 0.972), with moderate concordance in the PV (ρ = 0.866). Conservation of mass analysis showed concordance between large vessels (SRA vs. IVC; ρ = 0.806), small vessels (celiac vs. CHA + SpA; ρ = 0.939), and across capillary beds (CeT + SMA vs. PV; ρ = 0.862). Splanchnic flow was increased in patients with portosystemic shunting (PSS) relative to control patients and patients with cirrhosis without PSS (P < 0.05, difference range 0.11–0.68 liter/m). HARR was elevated and PRI was decreased in patients with PSS (3.55 and 1.49, respectively) compared to both the control (2.11/3.18) and non‐PSS (2.11/2.35) cohorts. Data Conclusion 4D flow MRI with self‐navigation was technically feasible, showing promise in quantifying the hemodynamic effects of cirrhosis. Proposed quantitative metrics of hepatic vascular resistance correlated with PSS. Level of Evidence 3 Technical Efficacy Stage 2

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Section: Discussionmentioning

confidence: 99%

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Brunsing

Brown

Almahoud

et al. 2021

Magnetic Resonance Imaging

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“…PSE has been proposed as an alternative to surgical splenectomy. PSE presents several advantages over splenectomy including reduced invasiveness of the procedure, short procedure time, early post-procedural ambulation, lack of a need J o u r n a l P r e -p r o o f for blood transfusion, and preservation of a part of splenic tissue function to protect against infections 2 . PSE, however, can have its complications, such as postembolization syndrome, splenic abscess, rupture of the spleen, pneumonia, pleural effusion, and septicemia.…”

Section: Discussionmentioning

confidence: 99%

“…Hypersplenism is a clinical disorder characterized by splenomegaly and a significant reduction in one or more of the cellular elements of the blood in the presence of normocellular or hypercellular bone marrow 1 . It can occur due to many underlying conditions including infiltrative disorders, malignancies and liver cirrhosis 2 . In patients with cirrhosis and portal hypertension, the incidence of hypersplenism has been described in between 11% and 55% 1 .…”

Section: Introductionmentioning

confidence: 99%

Successful Embolization of Spleen through Gastroepiploic Artery in a Liver Transplant Recipient with Splenic Artery Ligation

Bashir

Gupta

Agarwal

et al. 2022

Journal of Clinical and Experimental Hepatology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…However, the improvement of hypersplenism only lasted for 6 months after PSE when the splenic infarction rate was less than 50% and may need repeated phases of PSE [55], which would result in increasing the health care costs and surgical burden on patients. Moreover, PSE would cause abscess formation and liver failure when the infarction rate is more than 70%, which may lead to death in 1% of patients [56]. Although there is a risk of OPSI after splenectomy, the rate of OPSI mainly depends on age, indication for splenectomy, and ongoing immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of laparoscopic splenectomy for hypersplenism secondary to portal hypertension after transjugular intrahepatic portosystemic shunt

Liu

2021

BMC Gastroenterol

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Background Laparoscopic splenectomy (LS) being used after Transjugular intrahepatic portosystemic shunt (TIPS) has not been reported. This report aims to explore the feasibility, safety, and potential efficacy of LS after TIPS hypersplenism secondary to portal hypertension (PHT). Methods We retrospectively reviewed a series of six patients who underwent LS after TIPS for hypersplenism secondary to PHT between 2014 and 2020. The perioperative data and patients’ clinical outcomes were recorded. Results LS was successfully performed in all patients. Hypersplenism was corrected after LS in all six patients. Postoperative prothrombin time, prothrombin activity, international normalized ratio, and total bilirubin showed a trend toward improvement. The preoperative and 1-month postoperative albumin and activated partial thromboplastin levels showed no significant difference. Plasma ammonia level and thromboelastography indicators were ameliorated in two limited recorded patients. No postoperative complications such as subphrenic abscess, portal vein thrombosis, variceal bleeding, hepatic encephalopathy, and liver failure occurred during the 1-month follow-up period. Conclusion LS following TIPS is feasible, safe, and beneficial for patients with hypersplenism secondary to PHT. The following LS not only corrects the hypersplenism, but also has the potential to improve liver function.

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Adverse Events Related to Partial Splenic Embolization for the Treatment of Hypersplenism: A Systematic Review

Cited by 26 publications

References 53 publications

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Quantification of the Hemodynamic Changes of Cirrhosis with Free‐Breathing Self‐Navigated MRI

Successful Embolization of Spleen through Gastroepiploic Artery in a Liver Transplant Recipient with Splenic Artery Ligation

Efficacy and safety of laparoscopic splenectomy for hypersplenism secondary to portal hypertension after transjugular intrahepatic portosystemic shunt

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