Partial Splenic Artery Embolization for the Treatment of ITP: A Case Series-Pilot Study

Abstract

The purpose of this pilot study was to assess the effectiveness of partial splenic artery embolization (PSE), in the treatment and management of immune thrombocytopenia (ITP). Six patients with ITP who underwent PSE were followed up. The condition was either refractory to medications like steroids, intravenous immunoglobulin, immunosuppressants, or required very high doses of these drugs which could not be tapered down. Five out of six patients did not have good response even after adding immunosuppresants to steroids. The 6 patients who underwent PSE were followed up to 7 to 18 months with an average duration of 3.5 years. A therapeutic effect was defined as a platelet count of > 10,000/cumm (level below which spontaneous bleeding is likely to occur) at the last follow-up date with marked decrease in drug dosage. A good response was seen in all the patients – their doses of drugs could be reduced considerably and all had platelet count well above 10,000 during the last follow up after PSE. None of the patients who underwent embolization had any serious complications.

The use of splenic embolization in immune thrombocytopenia: A systematic review and meta‐analysis

“…While two studies provided the detailed measures of pain management, using continuous opioid infusion for up to 72 h post‐embolization, 13,33 others mentioned that post‐procedural pain was controlled with opioids without specific details 35,43 . Additionally, to mitigate the risk of post‐embolization infection in splenic tissue, certain studies employed post‐procedural prophylactic antimicrobial therapy 13,33,35,40 …”

“…Three studies utilized post‐procedure computed tomography (CT) scans, conducted between 1 and 4 weeks after SE, to evaluate effectiveness and ascertain the size of embolized splenic tissue 13,37,38 . One study employed post‐procedure angiography, 40 while three studies estimated the size of embolized splenic tissue through visual inspection during the procedure 7,34,35 . However, two studies did not report measures used to assess the degree of SE 36,39 …”

“…After exclusion of review publications and duplicate reports, 24 reports were included in the final analysis. Nine studies included five or more patients and these were used in the analysis of effectiveness (228 patients), 7,13,[34][35][36][37][38][39][40] and 15 studies were included in the safety analysis (151 patients). 13,16,22,31,[33][34][35][37][38][39][40][41][42][43][44]…”

“…All reports uniformly defined complete response as a platelet count greater than 100 × 10 9 /L, while most characterized partial response as platelet counts above 50 × 10 9 /L, except for two reports that defined partial response as a platelet count >30 × 10 9 /L 13,39 and one that defined response as a platelet count above 10 × 10 9 /L. 40 The overall response rate following SE ranged from 50% to 90% (Table 1), with a pooled estimate of 74.4% (95% CI: 64.9-83.9) using a random effects model, albeit with substantial heterogeneity observed between studies (I 2 = 59%, p < 0.0001; Figure 2). Complete response rates varied from 17% to 69% (Table 1), yielding a pooled estimate of 50.1% (95% CI: 38-62.3; Figure 2).…”

“…35,43 Additionally, to mitigate the risk of post-embolization infection in splenic tissue, certain studies employed postprocedural prophylactic antimicrobial therapy. 13,33,35,40…”