Splenic Artery Embolization for the Treatment of Bleeding Gastric Varices Secondary to Splenic Vein Thrombosis

Stone, Patrick A.; Phang, David; Richmond, Bryan K.; Gill, Gurpreet; Campbell, John E.

doi:10.1016/j.avsg.2013.07.014

Cited by 16 publications

(13 citation statements)

References 14 publications

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“…The recommended treatment for leftsided portal hypertension with recurrent variceal bleeding is splenectomy, which decreases the venous outflow through the collateral circulation and decompresses the associated varices. However, when splenectomy is deemed too hazardous, especially in patients after previous abdominal surgeries, as in our case, endovascular embolization of the splenic artery is a viable option [6]. In our patient, follow-up EGD after splenic artery embolization revealed the absence of both bleeding and gastric varices, suggesting that the treatment successfully diverted the blood flow, aborting the hepatic bypass.…”

Section: Discussionmentioning

confidence: 84%

“…The collateral blood flow through the gastric varices creates a shunt that bypasses the liver detoxification process. This phenomenon is known as leftsided portal hypertension, although the pressure in the portal system is normal [6]. The recommended treatment for leftsided portal hypertension with recurrent variceal bleeding is splenectomy, which decreases the venous outflow through the collateral circulation and decompresses the associated varices.…”

Section: Discussionmentioning

confidence: 99%

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Reversible Extrapyramidal Syndrome in a Patient with Splenic Vein Thrombosis without Overt Hepatic Dysfunction

Goldstein¹,

Maor²,

Inbar³

et al. 2017

J Neurol Neurosci

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Acquired hepatocerebral degeneration (AHD) is an extrapyramidal syndrome that develops secondary to hepatic dysfunction. It may accompany advanced liver disease and is related to the presence of portosystemic shunts. We describe a 44-year-old woman who presented with bleeding from gastric fundus varices secondary to splenic vein thrombosis and concomitant development of rapidly progressive extrapyramidal symptoms. No overt liver dysfunction was identified. Brain imaging demonstrated damage to the basal ganglia. The splenic artery was embolized with disappearance of the varices. Medical treatment consisted of amantadine and low-dose clonazepam for 6 months. The patient's neurologic symptoms gradually improved with few sequelae, although imaging demonstrated residual basal ganglia damage. This case highlights the need to identify reversible causes of AHD and treat them rapidly in order to halt progressive damage. The general prognosis of patients with AHD remains poor, and flow interruption in portosystemic shunts must always be taken into account. Rapid diagnosis and treatment could ameliorate the poor prognosis.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Reversible Extrapyramidal Syndrome in a Patient with Splenic Vein Thrombosis without Overt Hepatic Dysfunction

Goldstein¹,

Maor²,

Inbar³

et al. 2017

J Neurol Neurosci

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“…The increased pressure within the short gastric vein causes submucosal venous dilatation in gastric fundus. It has a potential risk of massive hemorrhage from gastric varices [2]. …”

Section: Introductionmentioning

confidence: 99%

Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

Kim

Park

Hur

et al. 2016

Case Reports in Medicine

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Splenic vein thrombosis is a relatively common finding in pancreatitis. Gastric variceal bleeding is a life-threatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Traditionally, splenectomy is considered the treatment of choice. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and bleeding tendency. In the Warshaw operation, gastric variceal bleeding is rare, even though splenic vein is resected. Because the splenic artery is also resected, blood flow to short gastric vein is not increased problematically. Herein, we report a case of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis successfully treated with splenic artery embolization. Splenic artery embolization could be the best treatment option for gastric variceal bleeding when splenectomy is difficult such as in case associated with severe acute pancreatitis or associated with severe adhesion or in patients with high operation risk.

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“…Specifically, in the transplant setting, splenic artery embolization has been effective in the management of splenic artery steal syndrome, a condition in which increased splenic blood flow due to low splenic arterial resistance, secondary to splenomegaly, siphons blood from the already decreased blood flow due to increased hepatic arterial resistance in the transplant liver, thereby decreasing liver blood flow. [31][32][33][34] Complications like bilomas are seen after HAT in orthoptic liver transplant. These can be successfully managed using percutaneous drainage techniques.…”

Section: Treatment Of Hepatic Artery Thrombosismentioning

confidence: 99%

Untitled

Pereira

Salsamendi²,

Dalal

et al. 2016

Exp Clin Transplant

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Objectives: Hepatic artery thrombosis remains a major complication after orthoptic liver transplant. Treatment of hepatic artery thrombosis is complex and requires a multidisciplinary approach. Retransplant is the procedure of choice. In nonsurgical candidates, endovascular options are evolving. Materials and Methods: Based on our experience at a busy transplant center, we discuss 4 representative cases to explain the potential role of endovascular treatment beyond just attempts at recanalization. From our experience, as well as a review of the literature, we propose a clinical practice algorithm for optimal treatment of hepatic artery thrombosis after orthoptic liver transplant. Results: The primary traditional endovascular interventional options remain thrombectomy, balloon angioplasty, and use of stents with the aim of revascularization. However, these methods have not proven to be effective. Ultrasonography-assisted thrombolysis, which has thus far been relatively less described in the hepatic vasculature, has the potential of producing the same angiographic results but at lower doses of the thrombolytic agent, thus decreasing the potential for hemorrhagic complications. The adjunctive use of splenic artery embolization and prompt treatment of biliary complications are in our opinion useful in "buying time" to allow adequate development of collateral "neovascularization of the liver," thus preventing further ischemia. Conclusions: Although surgical retransplant still remains the standard treatment for hepatic artery thrombosis, organ shortages and high mortality still exist. Endovascular techniques are rapidly evolving, but these techniques are dependent on expertise available and, even in the best hands, have not proven to be effective at reversing hepatic artery thrombosis. The use of a multimodality endovascular approach could salvage the liver allografts, thereby preventing retransplant or facilitating transplant at a more elective setting.

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Splenic Artery Embolization for the Treatment of Bleeding Gastric Varices Secondary to Splenic Vein Thrombosis

Cited by 16 publications

References 14 publications

Reversible Extrapyramidal Syndrome in a Patient with Splenic Vein Thrombosis without Overt Hepatic Dysfunction

Reversible Extrapyramidal Syndrome in a Patient with Splenic Vein Thrombosis without Overt Hepatic Dysfunction

Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

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