Embolization of the Spleen for Treatment of Splenomegaly and Hypersplenism in Patients with Portal Hypertension

Owman, T; Lunderquist, Anders; Alwmark, A; Börjesson, B

doi:10.1097/00004424-197911000-00003

Cited by 77 publications

(29 citation statements)

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“…The usual treatment has been splenectomy, but after reports that this operation is followed by an increased risk for fatal sepsis not only in childhood but also in adults [12,21], alternatives to splenectomy have been searched for. Ischemic therapy such as splenic artery ligation, arterial balloon occlusion or arterial embol ization have been advocated as means to reduce functional splenic mass [23,26,30], We have recently used pieces of gelatin sponge for emboliza tion of the splenic parenchyma as an alternative to splenectomy in patients with portal hypertension and hypersplenism [17], Promising results have been recorded from this method, but an optimal degree of reduction in order to obtain a normalization of peripheral cytopenia has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Hypersplenism An Experimental Study in the Rat

Alwmark

Bengmark

Börjesson³

et al. 1982

Eur Surg Res

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Methylcellulose injected intraperitoneally into rats proved to give a splenomegaly combined with anemia and thrombocytopenia. The white blood cell count did not change during the treatment. The splenic parenchyma of the hypersplenic rats was then reduced by resection or splenic artery ligation to a different extent. The peripheral blood cell count was normalized after a one-third resection, whereas a more-than-two-thirds reduction of the splenic parenchyma caused infective complications in many rats. It was thus possible to treat the ‘secondary hypersplenism’ in the rat by a partial reduction of the splenic parenchyma and to avoid total splenectomy, much undesired with new immunologic knowledge.

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Section: Introductionmentioning

confidence: 99%

Treatment of Hypersplenism An Experimental Study in the Rat

Alwmark

Bengmark

Börjesson³

et al. 1982

Eur Surg Res

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“…Sakai et al [20] observed two cases suffering from severe complications after PSE treatment in 17 patients with cirrhosis. Other severe complications of PSE treatment such as pleural effusion, rupture of spleen, portal vein thrombosis have also been reported [13,21,22] . In this study, embolization ranged from 50% to 70%.…”

Section: Discussionmentioning

confidence: 99%

Combined treatment of hepatocellular carcinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization

Huang¹,

Gao²,

Gu³

et al. 2007

WJG

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INTRODUCTIONTranscatheter hepatic arterial chemoembolization (TACE) has become the first choice of treatment for unresectable hepatocellular carcinoma (HCC) [1][2][3][4] . Since 70%-90% of HCC patients are associated with liver cirrhosis, portal hypertension and hypersplenism, treatment of HCC is usually affected by low peripheral blood cell counts (leukcytes, platelets and red blood cells) and high incidence of hemorrhagic complications due to treatment and/or portal hypertension [5][6][7][8] . Moreover, chemotherapeutics during TACE is another cause for low peripheral blood cell counts because of myelosuppression. Partial splenic embolization (PSE), which is thought to be an effective alternative to splenomegaly [9,10] because of its milder injury and fewer complications, has been widely used in treatment of leukocytopenia and thrombocytopenia caused by splenomegaly since the report of Maddison in 1973 [11] . MATERIALS AND METHODS PatientsFrom December 2002 to May 2006, 50 consecutive patients with HCC associated with hypersplenism caused by liver cirrhosis and portal hypertension were enrolled in this study. The diagnosis of HCC was established on the basis of clinical laboratory data, computed tomography and biopsy. The diagnosis of hypersplenism and splenomegaly was made in the light of clinical laboratory data and computed tomography. The enrolling criteria for this study were patients with splenomegaly and thrombocytopenia (platelet count ≤ 60 × 10 9 /L) and/or leukocytopenia (leukocyte count ≤ 3.0 × 10 9 /L). Adequate supporting therapies were performed for patients having severe peritonealgia before treatment with PSE and TACE or TACE alone in order to decrease the amount of ascites. Patients meeting the above criteria were randomly assigned to either group A or group B based on the computergenerated randomization sequences. Of the 50 patients, METHODS:Fifty patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were randomly assigned to 2 groups: group A receiving PSE combined with TACE (n = 26) and group B receiving TACE alone (n = 24). Follow-up examinations included calculation of peripheral blood cells (leukcytes, platelets and red blood cells) and treatment-associated complications. RESULTS:Prior to treatment, there was no significant difference in sex, age, Child-Pugh grade, tumor diameter, mass pathology type and peripheral blood cell counts between the 2 groups. After treatment, leukocyte and platelet counts were significantly higher in group A during the 3-mo follow-up period (P < 0.05), but lower in group B (P < 0.05). Severe complications occurred in 3 patients (11.5%) of group A and in 19 patients (79.2%) of group B (P < 0.05), and there was no significant difference in symptoms of post-embolization syndrome, including abdominal pain, fever, mild nausea and vomiting between the 2 groups (P > 0.05).CONCLUSION: PSE combined with TACE is more effective and safe than TACE alone for patients with HCC associated with hypersplenism caused by cirrhosis.

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“…13 One reason for this reduced risk could be that, after partial splenic embolization, the direction of flow in the splenic vein remains normal, reducing entry of bacteria from the portal circulation into the splenic vein. 12,14,15 Some authors advocate that splenectomy should always follow a total or partial splenic embolization to lessen the risk of splenic rupture or abscess formation.…”

Section: Discussionmentioning

confidence: 99%

“…12-14 A total of 74 embolizations were performed in the two largest series, 13,14 but only three patients developed abscesses. Two of three patients had undergone almost total embolization; in one the outcome was fatal.…”

Section: Discussionmentioning

confidence: 99%