Evaluation of Splenic Embolization in Patients with Portal Hypertension and Hypersplenism

Alwmark, A; Bengmark, S; Gullstrand, Per; Joelsson, B.; Lunderquist, Anders; Owman, T

doi:10.1097/00000658-198211000-00003

Cited by 82 publications

(46 citation statements)

References 35 publications

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“…Partial splenic embolization (PSE) is a safe and effective alternative for splenectomy in treatment of hypersplenism [64] . PSE helps in reduction of splenic volume, thus decreasing portal venous inflow and thereby reducing portal pressure.…”

Section: Partial Splenic Embolizationmentioning

confidence: 99%

Imaging and radiological interventions in extra-hepatic portal vein obstruction

Pargewar¹,

Desai²,

Rajesh³

et al. 2016

WJR

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Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS. Core tip: The present review describes the etiopathogenesis and role of imaging modalities in Extrahepatic portal vein obstruction and role of various radiological interventional procedures in its management. Pargewar SS et al . Imaging and interventions in EHPVOThe advantages and potential limitations of each imaging modality namely endoscopic retrograde cholangiography, ultrasonography and Doppler, multidetector computed tomography, magnetic resonance cholangiography and portovenography, endoscopic ultrasound and ultrasound transient elastography are discussed. Also, the concepts behind the use of interventional procedures like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, splenic artery aneurysmal embolization, balloon occluded retrograde obliteration of portosystemic shunt, etc. , are described.

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Section: Partial Splenic Embolizationmentioning

confidence: 99%

Imaging and radiological interventions in extra-hepatic portal vein obstruction

Pargewar¹,

Desai²,

Rajesh³

et al. 2016

WJR

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“…Estos hechos tienen enorme importancia desde el punto de vista quiriirgico 20 . Si bien la esplenectomia ha sido objetada por razones de orden inmunologico, y se ha sugerido que puede ser reemplazada por la ligadura de la arteria esplenica 23 , desde el punto de vista del procedimiento de desconexion la permanencia del organo in situ hace que la tecnica sea incompleta 20 . En el paciente comentado se utilize una tecnica modiftcada de desconexion, basada en la experiencia previa de 37 pacientes adultos con hipertension portal sometidos a procedimientos no derivatives 4 .…”

Section: Comentariounclassified

Hipertension portal extrahepatica: Desconexion acigos-portal

et al. 1990

Rev. chil. pediatr.

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Treatment of portal hypertension and gastroesophageal bleeding by azygos-portal disconnectionThe partial or complete obstruction of portal vein and 01 one of its branches is the most frequent cause of portal hypertension in children. A patient with extrahepatic portal hypertension and progresive course is presented, with great development of esophagogastric varices and multiple episodes of upper gastrointestinal hemorrhage. At the age of 9 years he was submitted to an azygos-portal disconnection by abdominal route, with manual transection of the esophagus, covered and protected by a gastric fundoplication. Postoperative endoscopic control demonstrated significant reduction in the size of esophageal varices and disapearance of gastric varices. Eleven months after surgery the patient was asymptomatic and a new endoscopic control showed no recurrence of varices. (Key words: portal system, hypertension, cavernomatous degeneration, esophageal varices, upper gastrointestinal bleeding, azygos-portal disconnection.) La obstruction de la vena porta es la causa mas frecuente de hipertension portal (HP) en los nifios. Su principal consecuencia es el desarrollo de una red colateral de circulation hepatofugal, dando origen a dilatationes varicosas en el territorio gastroesofagico. La hemorragia digestiva por lesion de las varices ocurre en 60-80% de estos pacientes, siendo necesario en algunas circunstancias recurrir a procedimientos quirurgicos para cohibirla o evitar su recurrencia 1 ' 2 . El objeto del presente trabajo es analizar una tecnica de desconexi6n acigos-portal modificada 3 ' 4 , efectuada en un paciente portador de cavernomatosis portal. CASO CLINICOPaciente de 9 afios, de procedencia rural, portador de hipertension portal por cavernomatosis de la porta, diagnosticada a los 4 anos de edad a rai'z de hemorragia digestive por varices esofagogastricas, episodio que se repftio tres aflos despues. Fue reevaluado con ecotomografia, radiografia contrastada del esofago y angiografia, certificandose la cavernomatosis portal y demostrandose extensas varices esofagicas. Se decidio en ese momento una conducta expectante para darle oportunidad de desarrollar circulation colateral suficiente. En 1989 se repitio el sangramiento digestive, apreciandose en la endoscopia varices esofagicas grado III a IV eroskmadas. Se efectuaron dos sesiones de escleroterapia, comprobandose en la endoscopia de control que, pese a la esclerosis, persistian paquetes varicosos mas voluminosos y prominentes que ochii'an parcialmente el lumen del esofago distal, razon por la cual se decidio no insistir con nuevas esclerosis. Habia, ademas, signos de hiperesplenismo con recuento de 3.000 leucocitos y 85.000 plaquetas x mm 3 en sangre periferica. Por tratarse de un paciente cuya enfermedad habia progresado, con alto riesgo de sangramiento por el tamafio de sus varices, fracaso de la escleroterapia y provenir de un sector rural, se decidio su tratamiento quinirgico.A la edad de 9 afios, seis despues del primer episodio de hemorragia digestiva, habiendo...

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“…The procedure was initially associated with significant morbidity and mortality, but subsequent series report substantially improved results [6]. We performed the embolization technique described by Spigos [1,3,6,8] because it has a very low risk of complications, although Israel et al [5] recently reported a lower rate of complications using polyvinyl alcohol.The increase in haemoglobin values found in our patient has been observed in patients affected by other diseases who have required PSE [5]. The thrombocytosis observed in our patient during the first 15 days after PSE that returned to normal values over 3 months, has been previously reported [3,5].…”

mentioning

confidence: 99%

mentioning

confidence: 99%

“…PSE is an accepted therapy for the treatment of secondary hypersplenism in various disorders, including oesophageal variceal haemorrhage [3], thalassaemia major [5], portal hypertension [1], painful splenomegaly [2], Gaucher disease [9], hypersplenism in cirrhosis [5], and prior to myelosuppressive treatment in hepatocarcinoma and active chronic hepatitis [2,3].…”

mentioning

confidence: 99%

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Partial splenic embolization in a child with hereditary spherocytosis

Moreno-Jiménez

Azcona

et al. 1995

Eur J Pediatr

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Partial splenic embolization (PSE) was introduced as an alternative to splenectomy to avoid the risk of post-splenectomy sepsis and to reduce the number of situations in which surgery would be dangerous or not feasible [5]. PSE is an accepted therapy for the treatment of secondary hypersplenism in various disorders, including oesophageal variceal haemorrhage [3] As an alternative to surgical splenectomy, PSE was performed on a 7-year-old girl with hereditary spherocytosis and hypersplenism who initially presented with a haemolytic crisis; haemoglobin values of 6.8 g/dl, jaundice and splenomegaly. She needed blood transfusions on two occasions due to persistent anaemia, with Hb values between 6.8-9 g/dl. PSE was performed following the Spigos protocol [8].Peripheral blood cell counts were repeated on days 1, 3, 7 and 15, and then 1, 3, 6, and 12 months after PSE (see Table 1). Abdominal ultrasound 1 month after PSE showed a 17% reduction in spleen size, with embolization of approximately 75% of the spleen.Maddison [7] performed the first successful splenic arterial embolization in 1973. The procedure was initially associated with significant morbidity and mortality, but subsequent series report substantially improved results [6]. We performed the embolization technique described by Spigos [1,3,6,8] because it has a very low risk of complications, although Israel et al. [5] recently reported a lower rate of complications using polyvinyl alcohol.The increase in haemoglobin values found in our patient has been observed in patients affected by other diseases who have required PSE [5]. The thrombocytosis observed in our patient during the first 15 days after PSE that returned to normal values over 3 months, has been previously reported [3,5]. This increase in platelet count appears to be

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Evaluation of Splenic Embolization in Patients with Portal Hypertension and Hypersplenism

Cited by 82 publications

References 35 publications

Imaging and radiological interventions in extra-hepatic portal vein obstruction

Imaging and radiological interventions in extra-hepatic portal vein obstruction

Hipertension portal extrahepatica: Desconexion acigos-portal

Partial splenic embolization in a child with hereditary spherocytosis

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