Splenic embolization monitored by the video dilution technique

Abstract

A patient with hypersplenism, massive splenomegaly, splenic vein thrombosis, and portal hypertension was man aged with preoperative embolization of the splenic artery.Blood flow measurements before, during, and after the embolization were determined by the video dilution tech nique [1][2][3][4]. After embolization, there was a marked fall in splenic blood flow, whereas hepatic and superior mesen teric artery flows increased significantly.Measurement of sequential flow degradation during em bolization allows controlled reduction of flow during embo lization, thereby potentially increasing the safety of emboli zation procedures [5]. We believe that the method has much promise for monitoring of partial splenic embolization [6, 7] in the treatment of hypersplenism. This patient's splanchnic hemodynamics were distinctly abnormal and interesting. The two-to threefold increase in flow through the splenic artery is known to occur sometimes in portal hypertension. The corresponding markedly dimin ished hepatic artery flow documents a "steal" phenomenon occurring in the celiac axis, which was reversed by the embolization procedure. The diminished relative superior

Improved Prognosis of Cirrhosis Patients with Esophageal Varices and Thrombocytopenia Treated by Endoscopic Variceal Ligation Plus Partial Splenic Embolization

“…Although the mechanism by which PSE improves liver function is still unclear, it has been suggested that immunological factors and hemodynamic changes are involved (32)(33)(34)(35). Regarding the former mechanism, an experimental study has shown that the spleen suppresses liver regeneration following partial hepatectomy, suggesting the production of suppressive factors by the spleen (36).…”

Advanced pancreatic carcinoma showing a complete response to arterial infusion chemotherapy

“…With the aim of improving the therapeutic results, we added embolization of the left gastric artery and short gastric artery and PSE to the conventional therapy to increase the flow in the great pancreatic artery and caudal pancreatic artery via the splenic artery. As it has been reported that hepatic arterial blood flow increased after PSE, 8 we surmised that the blood flow in the great pancreatic artery and caudal pancreatic artery would increase after PSE as well. Gemcitabine, a first-line chemotherapy agent for advanced pancreatic cancer, was introduced into the intraarterial regimen.…”

Simultaneous Combined Transjugular Intrahepatic Portosystemic Shunt and Partial Splenic Embolization for Decompensated Cirrhosis

“…Previous study [11] demonstrated that PSE has beneficial effects on liver function, enhancing hepatic protin synthesis capacity. The mechanism of improved liver function following PSE could be attributed to hemodynamic changes after PSE, which reduces portal venous flow, leading to a compensatory increase of blood flow in hepatic artery and superior mesenteric artery and vein [26,27] . This hemodynamic change may result in more nutritious blood flow to the liver, and may improve liver function and induce liver regeneration in cirrhotics [28,29] .…”