Partial splenic embolization: long-term outcome

Abstract

Background: Partial splenic embolization (PSE) was introduced in the 1980s. We studied the longterm follow-up results of a PSEtreated patient cohort. Patients and methods: Twenty-six severely ill patients (median age 63.5 years) were treated with a graded PSE a total of 52 times, mainly due to bleeding esophageal varices and thrombocytopenia. The aggregated follow-up time was 1715 months. Results: The mean values of hemoglobin, leukocytes and thrombocytes increased significantly after PSE. The frequency of bleeding episodes from esophageal varices was significantly reduced. No effect was observed concerning blood liver parameters in cirrhotic patients. The integrated PSE effect was judged as improvement in 19 patients, status quo in 5, and dete-rioration in 2. Median survival time was 50.5 months (range 0.5-272 months). Two patients underwent liver transplantation. Complications consisted mainly of fever, atelectasis, and abdominal pain. Two patients died of PSE-related complications. Conclusions: A standardized and graded PSE is reasonably safe even in patients with advanced disease in whom it is hazardous to splenectomize. It gives a long-term effect on the hematological parameters, bleedings from esophageal varices and good palliation, and improved clinical status contributing to symptomatic control.

Improved graft function in liver‐transplanted patients after partial splenic embolization: reversal of splenic artery steal syndrome?

“…All patients were male with a median age of 41 yr (21-60) and all had genotype 1. The median MELD score and spleen size before the procedure were 14 (9)(10)(11)(12)(13)(14)(15)(16)(17) and 20 cm (16-21) respectively.…”

“…These results strongly suggest a therapeutic effect of the procedure per se. Prior reports on the long-term outcome after PSE in non-transplanted patients showed no effect on the hepatic function (12) or only inconsistent findings indicated improvement in plasma cholesterol, proteins and coagulation parameters (13,14). The improvement in graft function before the initiation of peg-IFN plus RBV in our series might be related to the extensive volume of splenic infarction and, most importantly, to the reversal of an undiagnosed SASS that led to a better liver perfusion demonstrated by the reversal of histologic changes related to ischemia of the graft.…”

Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation

“…Xu and colleagues treated 41 patients with esophageal variceal bleeding by combination of EVL and partial SE; only one patient suffered from recurrent bleeding (2.4%) [40]. Pälsson et al reported a decrease of bleeding episodes from 4.3% to 1.1% in patients with liver cirrhosis, esophageal varices and thrombocytopenia treated with partial SE [41]. In a review of 5 studies including patients with PH, Koconis and co-authors demonstrated a reduction in bleeding episodes from 2.4 to 0.48 per year after SE [42].…”

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

“…Since then, multiple studies demonstrated the technical feasibility and efficacy of PSE for improving cytopenia. PSE has favorable outcomes in a variety of splenectomy indications, such as hypersplenism, splenic artery aneurysms, gastric variceal hemorrhage due to splenic vein thrombosis or PH, intra-operative blood loss during splenectomy and in hematological disorders, including idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia and hereditary spherocytosis[2,6,14,23-26]. …”