Clinical Application of Partial Splenic Embolization

Guan, Yong-Song; Hu, Ying

doi:10.1155/2014/961345

Cited by 52 publications

(52 citation statements)

References 53 publications

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“…Although major complications are not frequently observed in patients with IPH post-PSE, they occur more frequently and are associated with increased mortality in cirrhotic patients. In comparison with PSE, splenectomy is associated with more frequent major and minor complications[32-34,36]. Several studies reported a positive correlation between the splenic infarction rate and the complication rates.…”

Section: Discussionmentioning

confidence: 99%

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

Öztürk¹,

Eldem²,

Peynircioğlu³

et al. 2016

WJG

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AIMTo determine the outcomes of partial splenic embolization (PSE) for massive splenomegaly due to idiopathic portal hypertension (IPH).METHODSIn this prospective study, we evaluated the characteristics and prognosis of consecutive patients with IPH who underwent PSE for all indications at a single medical center between June 2009 and January 2015. The inclusion criteria were: presence of hypersplenism, massive splenomegaly, and resultant pancytopenia. The exclusion criteria were: presence of other diseases causing portal hypertension. During the post-PSE period, the patients were hospitalized. All patients underwent abdominal computed tomography imaging 4 wk post-PSE to determine total splenic and non-infarcted splenic volumes.RESULTSA total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm (21-28 cm), and severe hypersplenism was diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred.CONCLUSIONOur findings showed that PSE has a lower complication rate than previously-reported surgical complication rates, which supports this intervention as a viable alternative for high-risk operable patients with severe hypersplenism.

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Section: Discussionmentioning

confidence: 99%

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

Öztürk¹,

Eldem²,

Peynircioğlu³

et al. 2016

WJG

View full text Add to dashboard Cite

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“…[2122] With the development of interventional radiology, particularly the invention of new embolic materials, the application of PSE has been extended from hypersplenism to various diseases such as hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, and splenic trauma. [23] The first systemic review on PSE in the management of portal hypertension was published in 2007, and the most contemporary study noted in this review was reported in 2005. [24] This article thoroughly summarized the English-language literature and the benefits of PSE.…”

Section: Discussionmentioning

confidence: 99%

Partial splenic embolization has beneficial effects for the management of gastroesophageal variceal hemorrhage

Wang

Liu

Tong

et al. 2016

Saudi J Gastroenterol

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Background/Aims:Partial splenic embolization (PSE) is used in the management of gastroesophageal variceal hemorrhage (GEVH). However, it is uncertain whether it has beneficial effects for GEVH patients in preventing variceal recurrence and variceal hemorrhage, as well as promoting overall survival (OS), when it is combined with conventional therapies.Materials and Methods:The databases including PubMed, EMBASE, Web of Science, Google scholar, and Cochrane Central Register of Controlled Trials were searched up to 11th of November, 2015. Meta-analyses were performed by using Review Manager 5.3 software for analyzing the risk of bias, Newcastle-Ottawa Scale for assessing the bias of cohort studies, and GRADEprofiler software for assessing outcomes obtained from the meta-analyses.Results:A total of 1505 articles were reviewed, and 1 randomized controlled trial and 5 cohort studies with 244 participants were eligible for inclusion. The pooled hazard ratio (HR) of variceal recurrence is 0.50 (95% confidence interval (CI) 0.37, 0.68; P< 0.00001; I2 = 0%). The pooled HR of variceal hemorrhage is 0.24 (95% CI 0.15, 0.39; P< 0.00001; I2 = 0%). The pooled HR of OS is 0.50 (95% CI 0.33, 0.67; P< 0.00001; I2 = 0%). Meta-analyses demonstrated statistically significant superiority of combinational therapies over conventional therapies in preventing variceal recurrence and variceal hemorrhage and prolonging OS. The complications related to PSE were mild or moderate and nonfatal.Conclusions:The results indicate that PSE has beneficial effects for GEVH patients, however, future investigation with a larger number of subjects in clinical trials is warranted.

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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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Clinical Application of Partial Splenic Embolization

Cited by 52 publications

References 53 publications

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

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

Partial splenic embolization has beneficial effects for the management of gastroesophageal variceal hemorrhage

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