Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension

Öztürk, Ömer; Eldem, Gonca; Peynircioğlu, Bora; Kav, Taylan; Görmez, Ayşegül; Çil, Barbaros; Balkancı, Ferhun; Sökmensüer, Cenk; Bayraktar, Yusuf

doi:10.3748/wjg.v22.i43.9623

Cited by 15 publications

(12 citation statements)

References 37 publications

(79 reference statements)

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“…When described, selection of the splenic artery was performed through a parent catheter (4-8 Fr) followed by a coaxial microcatheter (2.1-3 Fr). 2,[9][10][11][12][13]23 The majority (11/12) of studies described distal embolization of the spleen, and on average, 59.5% (range: 20-100) of the spleen underwent infarction. Embolics used included gelatin sponge (3/12), polyvinyl alcohol particles (3/12), gel foam (3/12), coils (1/12), microspheres (2/12), and detachable balloons (1/12).…”

Section: Resultsmentioning

confidence: 99%

“…2 In contrast, partial splenic artery embolization (PSE) may only partially reduce splenic vein inflow and has recently been considered for the treatment of portal hypertension. 2,[4][5][6][7][8][9][10][11][12][13] Splenic artery embolization has been utilized effectively for both traumatic and nontraumatic indications, such as hematological disorders, malignancy, or hypersplenism. [14][15][16][17] This technique was first performed by Maddison et al in 1973 using autologous clot for embolization of the splenic artery in patients with recurrent gastrointestinal bleeding from esophageal varices.…”

mentioning

confidence: 99%

“…22 Several retrospective studies have demonstrated the efficacy of PSE for the treatment of portal hypertension. 2,[4][5][6][7][8][9][10][11][12][13]23 However, the technique and management of adverse effects are heterogeneous and incompletely understood. Moreover, the hemodynamic mechanism of reducing portal hypertension with splenic artery embolization is poorly understood because despite reduced splenic vein inflow, there may be compensatory flow from the mesenteric veins.…”

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confidence: 99%

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Partial Splenic Artery Embolization to Treat Portal Hypertension

Srinivas

Yeluru

Berman

et al. 2022

Digestive Disease Interventions

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Portal hypertension (PH) commonly occurs in the setting of underlying liver disease and can precipitate variceal bleeding and ascites among other complications. Traditionally, PH is managed with medication or lifestyle changes with refractory cases treated with transjugular intrahepatic portosystemic shunts or splenectomy. Partial splenic artery embolization (PSE) is an alternative treatment which may reduce PH by decreasing splenic vein inflow into the portal vein. In this article, we review the efficacy of PSE and present illustrative cases with a focus on technical and clinical considerations for embolization. We queried the PubMed database from August 1976 to September 2021 for clinical studies of PSE for the treatment of portal hypertension. For each article, the author, year, title, study design, number of patients, age, sex, liver function, technical considerations, adverse effects, and outcomes were recorded. We also review two successful and unsuccessful cases from our institution. A total of 12 studies were identified with 258 patients undergoing 290 PSE treatments. The mean age of patients was 44.1 years (range: 6–77). Most patients had well-compensated liver disease (Child–Pugh (CP) A; 35.1%) or significant functional compromise (CP-B; 44.4%), but a few had decompensated disease (CP-C; 8.9%). The majority (91.7%) of procedures were performed distally within the splenic artery, and on average, 59.5% (20–100) of the spleen underwent infarction. Common complications included symptoms of postembolization syndrome such as abdominal pain (58.5%) and fever (53.2%) as well as atelectasis (9.0%). Five PSE procedures (1.7%) resulted in death secondary to pleuropneumonia, splenic abscess, sepsis, intracranial hemorrhage, and pulmonary embolism, respectively. PSE is an effective but often underutilized treatment for PH. These benefits have risk for minor complications including postembolization syndrome and major complications such as splenic abscess formation. This article will introduce the reader to important technical and clinical considerations regarding PSE.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Partial Splenic Artery Embolization to Treat Portal Hypertension

Srinivas

Yeluru

Berman

et al. 2022

Digestive Disease Interventions

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“…The literature data indicate that complications after PSEE are rare, and they depend on the therapeutic method of exclusion of the circulation in the spleen (surgical or intravascular) with clear predominance of the intravascular method [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of partial splenic endovascular embolization in patients with refractory thrombocytopaenia

Rabczyński¹,

Fenc²,

Dybko³

et al. 2022

Pol J Radiol

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Purpose Partial splenic endovascular embolization (PSEE) could be an option for patients with thrombocytopaenia (TCP). We selected a group of 22 patients diagnosed with refractory TCP to undergo PSEE, and we followed them for detailed analysis. Material and methods Twenty-two patients aged 27-75 years (mean 46.5 ± 3.5 years) underwent PSEE, and 5 participants underwent a second PSEE due to the lack of effectiveness after the first procedure. A total of 27 PSEEs were performed. A semi-quantitative scale was used to assess the severity of the post-embolization syndrome. The percentage of spleen parenchyma excluded from circulation was 30-70%. We used the mixture of Histoacryl N-butyl cyanoacry-late glue and Lipiodol in 10 cases, spirals in 10 cases, and polyvinyl alcohol in 7 cases, for the embolization. Results The mean value of platelet count (PLT) before procedure increased from 22.0 ± 15.0 to 87.7 ± 67.9 ( p < 0.05) in a mean period of 194 days. In 2 cases severe post-embolization syndrome was observed. Closure less than 50% of the spleen circulation was associated with poorly expressed post-embolization symptoms. Serious complications occurred in 1 patient (3.5%). A strong positive correlation ( r = 0.8, p < 0.05) was found between C-reactive protein (CRP) and the severity of post-embolization syndrome. Increased symptoms of post-embolization syndrome were also associated with a significant increase in hospitalization time – 27.0 vs. 7.2 days ( r = 0.66, p < 0.05). Conclusions Partial endovascular embolization of the spleen (PSEE) may be a valuable therapeutic option for patients with refractory TCP. PSEE is a safe method with a low complication rate.

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“…Эта патология характеризуется длительным бессимптомным течением и часто дебютирует тромбозами различной локализации, в том числе и портальной системы. O. Ozturc с соавт., ссылаясь на исследование D. Valla с соавт., показали, что латентная форма ХМПЗ была обнаружена у 58% больных ТВВ, при этом у 51% из них диагноз ХМПЗ был поставлен в отдалённый период наблюдения [4].…”

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Portal vein thrombosis — a literature review and our own clinical observations

Luzina

Томина

Щаднева

et al. 2020

jour

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The portal vein thrombosis (PVT) is a partial or complete occlusion of blood flow through the portal vein that occurs due to the presence of a blood clot in its lumen. Currently, PVT has become more common in the clinic of internal diseases. PVT can be caused by many factors, among which local and systemic. Systemic factors include congenital and acquired thrombophilia. Local factors include inflammatory, infectious, and oncological diseases of the abdominal organs. One of the most likely causes of PVT is currently being considered liver cirrhosis. The article presents the literature data, clinical guidelines for managing patients with PVT in the discussion of three own clinical cases of patients with PVT, which were caused by various diseases.

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Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension

Cited by 15 publications

References 37 publications

Partial Splenic Artery Embolization to Treat Portal Hypertension

Partial Splenic Artery Embolization to Treat Portal Hypertension

Evaluation of the effectiveness of partial splenic endovascular embolization in patients with refractory thrombocytopaenia

Portal vein thrombosis — a literature review and our own clinical observations

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