Partial Splenic Artery Embolization in 35 Cancer Patients: Results of a Single Institution Retrospective Study

Kis, Béla; Mills, Matthew; Smith, J. Joshua; Choi, Junsung; Sagatys, Elizabeth M.; Komrokji, Rami; Strosberg, Jonathan R.; Kim, Richard D.

doi:10.1016/j.jvir.2019.05.031

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…All studies demonstrated frequent technical success as well as improvement in clinical outcomes. 2,[4][5][6][7][8][9][10][11][12][13]23 Concurrent with prior review studies, 24 there was a significant decrease in esophageal variceal bleeding likely secondary to lower wedge hepatic vein pressure, 26 portal venous pressure, 27 or gastric mucosal hemoglobin content. 28 These hematological and hemodynamic changes including decreased splenic and portal venous flow likely reflect pathological changes in the splenic parenchyma such as segmental infarction, degeneration, necrosis, and proliferation of fibrous tissue.…”

Section: Discussionmentioning

confidence: 72%

“…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%

“…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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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.…”

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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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