Partial Splenic Embolization for Hypersplenism in Cirrhotic Patients. A Case Series

Omer, Secil; Zara, Octavian; Iacobescu, Claudia; Dina, Ion

doi:10.15403/jgld.2014.1121.232.so1

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…However, even if the risk-benefit ratio supports PSE in these poor patients who require palliative treatment, the risk of severe complications makes preferable keeping them overnight if symptomatic treatment is needed. On the same way, although no recommendation exists regarding specific precautions against infection with PSE such as pneumococcal vaccination or prophylactic antibiotics, all patients in the present study were treated with these two options to minimize the risk of infectious complications, as those we can see after splenectomy, by analogy SC treatments, which involve oxaliplatin, have been linked to the appearance of distinctive liver lesions, such as hepatic sinusoids blockade, sclerosis of the perisinusoidal space, and veno-occlusive disease, affecting the normal hepatic parenchyma and occasioning portal hypertension (5,(19)(20)(21)(22)(23). Increases in spleen size, platelets splenic sequestration, and development of thrombocytopenia are surrogates of this toxicity.…”

Section: Discussionmentioning

confidence: 99%

Partial splenic embolization with Glubran®2/Lipiodol® mixture for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy

Loffroy¹,

Falvo²,

Nakaï³

et al. 2019

Quant. Imaging Med. Surg

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Background: Partial splenic embolization (PSE) has been used to improve thrombocytopenia related to hypersplenism. The optimal embolic agent is still debated. The purpose of this study was to evaluate the safety, hematologic response and outcomes of PSE with cyanoacrylate glue for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy (SC).Methods: Retrospective single-center observational report of cancer patients with thrombocytopenia related to hypersplenism and requiring SC who underwent PSE with N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) Glubran ® 2 glue between February 2015 and September 2017. All patients were treated under local anesthesia with a Glubran ® 2/Lipiodol ® mixture of 1:5 ratio. They all received empiric antibiotic coverage. Splenic volume and parenchyma infarction rate were evaluated by CT scan within 1 month of PSE. Primary and secondary endpoints of the current study included a platelet count increase >150×10 9 /L and the initiation of SC, respectively. Periprocedural laboratory values and adverse events were recorded.Results: PSE was performed in eight patients (6 males, 2 females; median age, 59 years; range, 33-75 years) for a technical success of 100%. For procedures with adequate follow-up, primary and secondary endpoints were achieved in 100% (7 of 7 patients) and 100% (7 of 7 patients) of patients, respectively. One patient died before follow-up, unrelated to the procedure. Mean splenic infarction post-PSE was 55% (range, 21-70%) on CT scan. For 7 patients with laboratory follow-up, the mean platelet count significantly increased from 74×10 9 /L [range, (62-83) ×10 9 /L] immediately before PSE to a peak level of 272×10 9 /L [range, (161-417) ×10 9 /L] 10 days after PSE (P<0.05). All patients could receive SC after PSE. No non-target glue embolization occurred. All patients experienced a transient and moderate postembolization syndrome. No severe postembolization syndrome occurred. No major complication was reported. The mean overall survival was 7.9 months (range, 0.6-10.4 months) among the 8 patients after PSE. Conclusions: PSE with cyanoacrylate glue is safe and effective in the management of thrombocytopenia related to hypersplenism in cancer patients. It allows sufficient platelet count improvement for administration of SC.

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Section: Discussionmentioning

confidence: 99%

Partial splenic embolization with Glubran®2/Lipiodol® mixture for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy

Loffroy¹,

Falvo²,

Nakaï³

et al. 2019

Quant. Imaging Med. Surg

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“…The success of splenic artery embolization in correcting cytopenias is due to the decreased rate of consumption of blood cells in the spleen from the blocked off blood flow to the spleen [6] . Improvement in cytopenias are seen when the amount of infarcted spleen exceeds 50% [4,21] , with the increase in platelet counts suggested to be correlated with the size of splenic infarction and splenic volume loss post embolization [6] . In one study of six patients who underwent splenic artery embolization due to hypersplenism, the peak platelet counts were achieved at one month post-embolization [6] .…”

Section: Discussionmentioning

confidence: 99%

“…The procedure's full therapeutic potential has been increasingly studied over just the past decade, with the majority of literature reported in liver disease with cirrhosis and portal hypertension-related hypersplenism. It has been reported as both a palliative and curative procedure in treatment of pathologic hyperslenism as seen in cases of chronic ITP [23,24] , paroxysmal nocturnal hemoglobinuria [25,26] , thalassemia [27,28] , gaucher's disease [29,30] , cirrhosis [21,31,32] , hereditary spherocytosis [33] , and renal transplant recipients [34] . SAE is even now being advocated as indicated in cases of cytopenias limiting treatment options in cancer patients such as colorectal, pancreatic or hepatocellular carcinoma, where treatment with marrow suppressive chemotherapeutics are vital [35] .…”

Section: Discussionmentioning

confidence: 99%

Splenic artery embolization as a bridge to splenectomy in severe transfusion-refractory thrombocytopenia secondary to myelodysplastic syndrome

Emadi¹,

Holtzman²,

Duong³

et al. 2016

IJHT

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Transfusion-refractory thrombocytopenia is an important clinical challenge in the treatment of patients with myelodysplastic syndrome. Hypersplenism can play a major role in splenic platelet sequestration and transfusion refractoriness, and though rare in myelodysplastic syndrome, it can commonly be seen in a wide range of other benign and malignant conditions. Splenectomy has been an effective approach in management of hypersplenism-induced cytopenias, however those who are unresponsive to platelet transfusions are not surgical candidates making this an unfeasible treatment option. There has been increasing interest in the therapeutic value of the less invasive procedure of splenic artery embolization. Here we report the first case of a patient with myelodysplastic syndrome complicated by hypersplenism and severe transfusion-refractory thrombocytopenia in which a splenic artery embolization was successfully used as a bridge to splenectomy, which resulted in platelet transfusion responsiveness and correction of her thrombocytopenia. Reversal of severe thrombocytopenia has multiple important therapeutic values including allowing patients to safely continue receiving myelosuppressive chemotherapy treatments which are sometimes delayed or dose-adjusted due to cytopenias, safely undergo surgical interventions and also open the door for candidacy for stem cell transplantation. In conclusion, splenic artery embolization with or without subsequent splenectomy is highly recommended as a safe therapeutic option in patients with hematologic malignancies.

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“…PSE was also carried out by the same interventional radiologists, according to the method described in previous studies [8,15] . During the procedure, a 5.0-F RH or Yashiro catheter (Terumo, Tokyo, Japan) was used to demonstrate the distribution of splenic arteries and collateral circulation routes, and spring coils(18-6/2mm, 18-10/4mm, Cook Inc., Bloomington, IN, USA) were used to embolize branches of the splenic arteries with a splenic infarction ratio set at below 50% ( Figure 2B).…”

Section: Pse Proceduresmentioning

confidence: 99%

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

Wan

Yang

et al. 2016

Journal of Gastroenterology and Hepatology Research

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AIM:To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in combination with partial splenic arterial embolization (PSE) for cirrhotic patients with recurrent variceal bleeding and hypersplenism. METHODS: Institutional review board approval was obtained; all patients provided informed consent. From January 2010 to December 2014, a total of 141 cirrhotic patients received TIPS alone(group A, n=114) and simultaneous combined TIPS and PSE(group B, n=27) for recurrent variceal bleeding and hypersplenism secondary to portal hypertension. The TIPS was created by using covered stents. All patients underwent embolotherapy via the jugular vein after TIPS implantation. Patients in group B (n=27) received simultaneous PSE after creation of TIPS. Biochemical tests, coagulation function, complete blood cell (CBC) counts, frequencies of recurrent variceal bleeding and hepatic encephalopathy (HE), and survival were evaluated. Model for end stage liver diseases (MELD) scores were calculated. RESULTS: TIPS creation was successful in all patients. After the treatments, patients in group B had better hepatic synthetic function, increased levels of white blood cells (WBC), platelets (PLT), and hemoglobin(HGB), lower frequency of HE, lower overall and cirrhosis-related mortality than patients in group A (P<0.05), though the two groups had similar recurrent variceal bleeding frequency (P>0.05). Multivariate analysis showed that MELD scores, HE, and group were independent factors for overall and liver-related mortality at month 24 (P<0.05). No severe complications were observed in the two groups. CONCLUSIONS: Simultaneous combined TIPS and PSE regimen improves hematologic parameters, prevents deterioration of liver function and coagulation function, reduces variceal bleeding and HE, thus reduces mortality.

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Partial Splenic Embolization for Hypersplenism in Cirrhotic Patients. A Case Series

Cited by 7 publications

References 9 publications

Partial splenic embolization with Glubran®2/Lipiodol® mixture for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy

Partial splenic embolization with Glubran®2/Lipiodol® mixture for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy

Splenic artery embolization as a bridge to splenectomy in severe transfusion-refractory thrombocytopenia secondary to myelodysplastic syndrome

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

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