Splenic Artery Syndrome After Orthotopic Liver Transplantation: Treatment With the Amplatzer Vascular Plug

Maurer, Martin; Mogl, Martina T.; Podrabský, P; Denecke, Timm; Grieser, Christian; Fröling, Vera; Scheurig-Muenkler, Christian; Guckelberger, Olaf; Kroencke, Thomas J.

doi:10.1007/s00270-010-0083-9

Cited by 14 publications

(13 citation statements)

References 23 publications

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“…Surgical approaches include formation of an aortohepatic conduit or splenic arterial banding or ligation [38] . Proximal splenic artery embolization, via deployment of coils or an Amplatzer plug in the splenic artery immediately distal to the pancreatic and short gastric arteries, has been established as a safe and effective option in the non-surgical management of SASS [39][40][41][42] .…”

Section: Splenic Artery Steal Syndromementioning

confidence: 99%

Partial splenic artery embolization in cirrhotic patients

Hadduck¹,

McWilliams²

2014

WJR

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Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications. Key words: Partial splenic embolization; Cirrhosis; Liver disease; Thrombocytopenia; Leukopenia Core tip: Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst cirrhotic patients that are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome.Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol 2014; 6(5): 160-168 Available from:

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Section: Splenic Artery Steal Syndromementioning

confidence: 99%

Partial splenic artery embolization in cirrhotic patients

Hadduck¹,

McWilliams²

2014

WJR

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“…Kim et al12 found that splenic artery embolization significantly increased the diameter of the common hepatic artery and steadily decreased the diameter of the splenic artery according to computerized tomography. Maurer et al25 and Mogl et al11 reported that selective splenic artery embolization improved liver perfusion and promoted the recovery of liver function after OLT without concomitant severe complications. Uflacker et al26 demonstrated that selective splenic artery embolization led to immediate clinical improvement, but thrombosis was a potential complication.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound diagnosis of splenic artery steal syndrome after orthotopic liver transplantation

et al. 2012

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The aim of this study was to investigate the use of contrast-enhanced ultrasound (CEUS) for the detection of splenic artery steal syndrome (SASS) after orthotopic liver transplantation (OLT). Two hundred forty-seven patients underwent OLT. Blood tests and color Doppler flow imaging (CDFI) were performed at various time points after the operation. CEUS and celiac angiography were used for patients suspected of having SASS. If the diagnosis of SASS was confirmed, splenic artery embolization was performed to enhance hepatic artery flow. CEUS and angiography were performed for the assessment of postinterventional clinical outcomes. Three of the 247 patients died postoperatively, and 8 patients were suspected of having SASS because of elevated liver enzyme levels and slim or undetectable hepatic artery blood signals by CDFI at various points after the operation. In these 8 patients, CEUS showed a delayed and weak contrast-enhanced blood signal in the hepatic artery associated with a rapid and intense enhancement of the portal vein blood. No narrowing of the hyperintense signal was observed in the hepatic artery by CEUS. The 8 diagnoses of SASS were proven by celiac angiography, which showed delayed perfusion of the hepatic artery and rapid filling of the splenic artery. Immediately after the interventional procedure, CEUS demonstrated a significantly enlarged hyperintense blood signal in the hepatic artery. In conclusion, approximately 3.27% of SASS cases occur after OLT. SASS can be identified as a sluggish and weak hyperintense blood signal in the hepatic artery without the narrowing and interruption of the hypointense signal in CEUS imaging. CEUS is an effective imaging modality for the detection of SASS after OLT. Liver Transpl 18:966-971, 2012. V C 2012 AASLD.

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“…2 Despite these advancements, the occlusion time is still unpredictable. 1,6 The manufacturer recommends repeating angiograms every 5 minutes until complete stasis of the injected contrast is noted; however, this is problematic due to the prolonged radiation, contrast dose, and lengthened procedural time. Although there is not a fixed threshold amount of time, if thrombosis is not achieved within 10 to 15 minutes, many operators prefer to place a second plug or use additional coils, glue, or large gelatin sponge particles.…”

Section: Potential Challenges Of Using the Avpmentioning

confidence: 99%

“…2,26 The AVP has been used for SA embolization in cases of trauma, hypersplenism, the treatment of portal hypertension complications, and SA steal syndrome. 2,6,7,10,[26][27][28] The main challenge occurs in those patients with very tortuous SA where advancing the delivery sheath can be very difficult. 2 The mean occlusion time was on average 10 minutes for patients with SA syndrome and trauma.…”

Section: Splenic Artery Embolizationmentioning

confidence: 99%

“…2 The mean occlusion time was on average 10 minutes for patients with SA syndrome and trauma. 6,27 A significant difference in the occlusion time has been described, with patients with portal hypertension and SA steal syndrome requiring more coils or AVPs to achieve complete occlusion due to their hyperdynamic circulation and larger size vessels than trauma patients. 2 In the study by Zhu et al comparing AVP I and II versus coils, there was no statistically significant difference in average procedural time, mean occlusion time, or average cost of the embolic material; there was, however, a statistically significant difference in the radiation dose in each group, with an average dose of 842 mGy in the AVP group and 1,309 mGy in the coil group.…”

Section: Splenic Artery Embolizationmentioning

confidence: 99%

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The Amplatzer Vascular Plug: Review of Evolution and Current Applications

Lopera

2015

Semin intervent Radiol

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The Amplatzer Vascular Plug (AVP) was created for peripheral embolization as a modification of the family of Amplatz septal occluders used in the treatment of congenital heart malformations. The device has evolved over the years and multiple versions have been launched into the market. Each of the versions of the device has some important modifications in terms of the size of the introducer's system, number of layers, and resultant thrombogenicity. It is very important for the operator to become familiar with the unique features of the AVP, and to understand the advantages and limitations of each model in the AVP family to achieve an optimal embolic result. The purpose of this article is to review the evolution and current clinical applications of the AVP in the field of interventional radiology, with emphasis on the advantages and limitations of this device in comparison with other embolization agents.

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Splenic Artery Syndrome After Orthotopic Liver Transplantation: Treatment With the Amplatzer Vascular Plug

Abstract: Our initial experience in a small patient population with SAS suggests that the AVP enables precise embolization of the proximal splenic artery, thus providing safe and effective treatment for poor liver perfusion after OLT due to SAS.

Cited by 14 publications

References 23 publications

Partial splenic artery embolization in cirrhotic patients

Partial splenic artery embolization in cirrhotic patients

Contrast-enhanced ultrasound diagnosis of splenic artery steal syndrome after orthotopic liver transplantation

The Amplatzer Vascular Plug: Review of Evolution and Current Applications

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