Partial splenic embolization for thrombocytopenia in liver cirrhosis: predictive factors for platelet increment and risk factors for major complications

Cai, Mingyue; Huang, Wensou; Chen, Lin; Li, Zhengran; Qian, Ji; Huang, Mingsheng; Zeng, Zhilin; Huang, Jingjun; Song, Hong; Zhu, Kangshun

doi:10.1007/s00330-015-3839-4

Cited by 35 publications

(29 citation statements)

References 21 publications

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“…Even though it revealed its value, it took a while for splenic embolization to get more accepted due to an elevated rate of adverse events, mainly spleen abscess formation, sepsis, spleen disruption, pancreas inflammation due to nontarget embolization and severe pulmonary infection . Recent literature, however, has demonstrated significant reduction in complication and mortality rates resulting from various reasons including improvements in the available materials for transcatheter embolization and angiography equipment, added to the changes in the PSE procedure, learned throughout the past 20 years .…”

Section: Introductionmentioning

confidence: 99%

Partial splenic embolization to permit continuation of systemic chemotherapy

Luz

Marchiori

et al. 2016

Cancer Medicine

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Systemic chemotherapy treatments, commonly those that comprise oxaliplatin, have been linked to the appearance of distinctive liver lesions that evolves to portal hypertension, spleen enlargement, platelets sequestration, and thrombocytopenia. This outcome can interrupt treatment or force dosage reduction, decreasing efficiency of cancer therapy. We conducted a prospective phase II study for the evaluation of partial splenic embolization in patients with thrombocytopenia that impeded systemic chemotherapy continuation. From August 2014 through July 2015, 33 patients underwent partial splenic embolization to increase platelets count and allow their return to treatment. Primary endpoint was the accomplishment of a thrombocyte level superior to 130 × 109/L and the secondary endpoints were the return to chemotherapy and toxicity. Partial splenic embolization was done 36 times in 33 patients. All patients presented gastrointestinal cancer and colorectal malignancy was the commonest primary site. An average of 6.4 cycles of chemotherapy was done before splenic embolization and the most common regimen was Folfox. Mean platelet count prior to embolization was 69 × 109/L. A total of 94% of patients achieved primary endpoint. All patients in need reinitiated treatment and median time to chemotherapy return was 14 days. No grade 3 or above adverse events were identified. Aiming for a 50% to 70% infarction area may be sufficient to achieve success without the complications associated with more extensive infarction. Combined with the better safety profile, partial splenic embolization is an excellent option in the management of thrombocytopenia, enabling the resumption of systemic chemotherapy with minimal procedure‐related morbidity.

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Section: Introductionmentioning

confidence: 99%

Partial splenic embolization to permit continuation of systemic chemotherapy

Luz

Marchiori

et al. 2016

Cancer Medicine

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“…Yamamoto et al reported that they could perform the treatment of HCC safely for patients who received splenectomy, and this contributed to prolonged OS in patients who underwent splenectomy compared with those who did not undergo splenectomy [31]. Although partial splenic embolization is another effective modality that is less invasive in patients with hypersplenism, some investigators have reported disadvantages such as high recurrence rates of thrombocytopenia and the possibility of infectious complications [32][33][34]. The Sp ?…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes after splenectomy with gastric devascularization or balloon-occluded retrograde transvenous obliteration for gastric varices: a propensity score-weighted analysis from a single institution

et al. 2020

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Background Although balloon-occluded retrograde transvenous obliteration (BRTO) is often selected to treat gastric varices caused by portal hypertension, data comparing BRTO and splenectomy with gastric devascularization (Sp ? Dev) are limited. Methods From January 2009 to February 2018, 100 patients with gastric varices caused by portal hypertension who underwent Sp ? Dev (n = 45) or BRTO (n = 55) were included. Overall survival (OS) and the rebleeding rate were calculated using the inverse probability of a treatment weighting-adjusted log-rank test. Independent risk factors were identified by Cox regression analysis. Changes in liver function and adverse events after the procedures were analyzed. Results Patients in the Sp ? Dev group tended to have lower platelet counts than those in the BRTO group, but liver function did not differ between these groups. The 5-year OS rates for the Sp ? Dev and BRTO groups were 73.4 and 50.0% (p = 0.005), respectively. There were no significant differences in rebleeding rates between the two groups. Multivariate analysis showed that serum albumin level B3.6 g/dL, prothrombin time% activity (PT%) B80%, and serum creatinine level C0.84 mg/dL were poor prognostic factors. Although the Sp ? Dev group had more short-term complications after procedures, Sp ? Dev tended to be more effective in improving liver function than BRTO. Conclusions Sp ? Dev showed better OS and improvement of liver function compared with BRTO for the treatment of gastric varices caused by portal hypertension.

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“…Cai с соавт. (2016) исследовали прогностические факторы послеоперационного увеличения уровня тромбоцитов и факторы риска серьезных послеоперационных осложнений [15]. Выяснилось, что эффективность прироста тромбоцитов в значительной степени зависит от соотношения объемов зоны инфаркта и остальной части селезенки.…”

Section: современное состояние проблемыunclassified

Partial embolization of splenic lienal artery as related to patients with portal hypertension: current state of the issue (literature review)

Nikishin¹,

Kozlov²,

Altman³

et al. 2018

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эндоваскулярной нейрорентгенохирургии НАМН Украины», г. Киев 2 Национальный медицинский университет имени А.А. Богомольца, г. Киев 3 Национальная медицинская академия последипломного образования имени П.Л. Шупика, г. Киев СОСТОЯНИЕ ПРОБЛЕМЫ ПАРЦИАЛЬНОЙ ЭМБОЛИЗАЦИИ СЕЛЕЗЕНОЧНОЙ АРТЕРИИ ПРИ ПОРТАЛЬНОЙ ГИПЕРТЕНЗИИ (ОБЗОР ЛИТЕРАТУРЫ) Представлен современный взгляд на проблему применения парциальной эмболизации селезеночной артерии у пациентов с портальной гипертензией. Анализ литературных источников выявил, что редукция селезеночного кровотока является эффективным методом коррекции портальной гипертензии. Предложены методики выполнения такой редукции, при этом выбор оптимальной методики остается предметом дискуссий. Инфаркты селезенки более 70 % объема органа могут приводить к абсцессу селезенки. Если объем эмболизированной ткани составляет менее 50 %, то клинический эффект может быть недостаточным. Сочетание парциальной эмболизации селезеночной артерии с эндоскопическими и медикаментозными методами эффективно в лечении гастроэзофагальных кровотечений, обусловленных портальной гипертензией. Количество, качество и масштаб исследований по данной проблеме недостаточны. Необходимо провести многоцентровые международные исследования с большой выборкой для определения места упомянутой методики в лечении пациентов с портальной гипертензией. Ключевые слова: эмболизация селезеночной артерии; портальная гипертензия; цирроз печени; трансплантация печени; варикоз вен пищевода; гиперспленизм; спленомегалия. *Conflict of Interest Statement (We declare that we have no conflict of interest). *Заява про конфлікт інтересів (Ми заявляємо, що у нас немає ніякого конфлікту інтересів). *Заявление о конфликте интересов (Мы заявляем, что у нас нет никакого конфликта интересов). *No human/animal subjects policy requirements or funding disclosures. *Жодний із об'єктів дослідження (людина/тварина) не підпадає під вимоги політики щодо розкриття інформації фінансування. *Ни один из объектов исследования не подпадает под политику раскрытия информации финансирования.

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Partial splenic embolization for thrombocytopenia in liver cirrhosis: predictive factors for platelet increment and risk factors for major complications

Cited by 35 publications

References 21 publications

Partial splenic embolization to permit continuation of systemic chemotherapy

Partial splenic embolization to permit continuation of systemic chemotherapy

Treatment outcomes after splenectomy with gastric devascularization or balloon-occluded retrograde transvenous obliteration for gastric varices: a propensity score-weighted analysis from a single institution

Partial embolization of splenic lienal artery as related to patients with portal hypertension: current state of the issue (literature review)

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