Partial splenic embolization of patients with hypersplenism by transradial or transfemoral approach: a prospective randomized controlled trial

Wu, Tao; Sun, Ruimin; Huang, Yinuo; Wang, Zhixue; He, Jue; Shen, Songhe; Xi, Yin; Zhu, Zhixiang; Yang, Wenyi; Zhao, Zhijun

doi:10.1177/0284185115622076

Cited by 11 publications

(9 citation statements)

References 22 publications

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“…Although most frequently performed via a transfemoral approach, patients undergoing PSE via transradial approach for hypersplenism had a shorter procedure time, X-ray exposure time, and hospital length of stay in a prospective randomized controlled trial. 62 For patients in whom endovascular access may be difficult, PSE under endoscopic-ultrasound guidance has also been shown to be an effective treatment for portal hypertension. 63 Similarly, for patients in whom catheterization of the splenic artery is difficult due to anatomic constraints or atherosclerotic disease, PSE via the gastroepiploic collaterals has been shown to be a viable alternative for the treatment of hypersplenism.…”

Section: Discussionmentioning

confidence: 99%

Partial Splenic Artery Embolization to Treat Portal Hypertension

Srinivas

Yeluru

Berman

et al. 2022

Digestive Disease Interventions

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Portal hypertension (PH) commonly occurs in the setting of underlying liver disease and can precipitate variceal bleeding and ascites among other complications. Traditionally, PH is managed with medication or lifestyle changes with refractory cases treated with transjugular intrahepatic portosystemic shunts or splenectomy. Partial splenic artery embolization (PSE) is an alternative treatment which may reduce PH by decreasing splenic vein inflow into the portal vein. In this article, we review the efficacy of PSE and present illustrative cases with a focus on technical and clinical considerations for embolization. We queried the PubMed database from August 1976 to September 2021 for clinical studies of PSE for the treatment of portal hypertension. For each article, the author, year, title, study design, number of patients, age, sex, liver function, technical considerations, adverse effects, and outcomes were recorded. We also review two successful and unsuccessful cases from our institution. A total of 12 studies were identified with 258 patients undergoing 290 PSE treatments. The mean age of patients was 44.1 years (range: 6–77). Most patients had well-compensated liver disease (Child–Pugh (CP) A; 35.1%) or significant functional compromise (CP-B; 44.4%), but a few had decompensated disease (CP-C; 8.9%). The majority (91.7%) of procedures were performed distally within the splenic artery, and on average, 59.5% (20–100) of the spleen underwent infarction. Common complications included symptoms of postembolization syndrome such as abdominal pain (58.5%) and fever (53.2%) as well as atelectasis (9.0%). Five PSE procedures (1.7%) resulted in death secondary to pleuropneumonia, splenic abscess, sepsis, intracranial hemorrhage, and pulmonary embolism, respectively. PSE is an effective but often underutilized treatment for PH. These benefits have risk for minor complications including postembolization syndrome and major complications such as splenic abscess formation. This article will introduce the reader to important technical and clinical considerations regarding PSE.

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Section: Discussionmentioning

confidence: 99%

Partial Splenic Artery Embolization to Treat Portal Hypertension

Srinivas

Yeluru

Berman

et al. 2022

Digestive Disease Interventions

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“…Seven years later, transcatheter partial splenic embolization (PSE) was developed by Spigos et al [17], which has been proved as a safe and effective method of vascular occlusion. Partial splenic embolization is usually performed by inserting a catheter through the femoral artery or radial artery approach [18]. The injection of embolic agent through the catheter causes necrosis of part of the splenic tissue, reduces the volume of the spleen, reduces the retention of blood cells, reduces the phagocytic and destructive ability of monocyte-macrophages, and thus increases the number of peripheral blood cells.…”

Section: Discussionmentioning

confidence: 99%

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Zheng

Liang

et al. 2021

BMC Gastroenterol

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Background To investigate the safety and efficacy of 8Spheres in partial splenic embolization. To explore the possibility of accurate control of splenic embolic volume by quantifying the number of microspheres used during PSE. Method The data of 179 patients who underwent PSE were collected. The patients were divided into two groups: 300–500 um microsphere group (N = 83) and 500–700 um microsphere group (N = 96). The spleen volume before PSE, infarct volume and infarct rate of the spleen after PSE, changes in peripheral blood cells after PSE, postoperative adverse events and incidence of infection were compared between the two groups. Results 300–500 um group vs 500–700 um group: postoperative spleen volume (cm3): 753.82 ± 325.41 vs 568.65 ± 298.16 (P = 0.008); spleen embolization volume (cm3): 525.93 ± 118.29 vs 630.26 ± 109.71 (P = 0.014); spleen embolization rate: 41.1 ± 12.3% vs 52.4 ± 10.1% (P = 0.021). Leukocytes and platelets were significantly increased after PSE in both groups; leukocyte, 1 month: 4.13 ± 0.91 vs 5.08 ± 1.16 (P = 0.026); 3 months: 4.08 ± 1.25 vs 4.83 ± 0.98 (P = 0.022); platelet, 1 month: 125.6 ± 20.3 vs 138.7 ± 18.4 (P = 0.019); 3 months: 121.8 ± 16.9 vs 134.3 ± 20.1 (P = 0.017). Incidence of abdominal pain after PSE, 72 (86.7%) vs 69 (71.9%), P = 0.027. The incidence of other adverse events and infections after PSE was not statistically different. Conclusion PSE with 8Spheres is safe and effective. The use of 500–700 um microsphere for PSE can make the increase of peripheral blood cells more stable. Each vial of 8Spheres corresponds to a certain volume of splenic embolization, so it is possible to achieve quantitative embolization in PSE.

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“…O hiperesplenismo é uma complicação comum observada em pacientes com cirrose hepática que evolui com hipertensão portal. Existem várias modalidades de tratamento para o hiperesplenismo, incluindo tratamento conservador, embolização esplênica parcial, esplenectomia, transplante de fígado, ablação por radiofrequência e métodos com ultrassom de alta frequência 63 .…”

Section: Embolização Esplênicaunclassified

“…A embolização esplênica parcial é um tratamento efetivo para pacientes com hiperesplenismo. É menos invasiva, associada a menos dor, recuperação mais rápida, menor tempo de internação hospitalar e menor incidência de trombose portal, quando comparada com procedimentos cirúrgicos 63 .…”

Section: Embolização Esplênicaunclassified

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Acesso radial distal guiado por ultrassonografia para intervenções transarteriais abdominopélvicas

Junior¹

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A meus pais, Adib e Lucimar, pelos ensinamentos, amor incondicional e apoio em todos os momentos de minha vida.A minha querida esposa, Fábia, pelo amor, apoio e compreensão em todos os momentos.A meus queridos filhos Maria Eduarda, Paulo e Ayla, pelo amor sem o qual nada valeria a pena.A meu irmão, Adilon, como exemplo de pessoa e profissional.A minha sobrinha e afilhada Ana Beatriz e minha cunhada Gisele, pelo apoio e incentivo. AGRADECIMENTOSA meu orientador, Prof. Dr. Daniel Giansante Abud, pelo respeito, dedicação e empenho com que conduziu todo o processo desta tese.Ao Prof. Dr. Lucas Moretti Monsignore, pelas orientações, dedicação e contribuições durante todo o estudo para elaboração desta tese.

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Partial splenic embolization of patients with hypersplenism by transradial or transfemoral approach: a prospective randomized controlled trial

Abstract: The transradial artery approach for PSE in patients with hypersplenism is feasible with no major complications as compared to the femoral approach.

Cited by 11 publications

References 22 publications

Partial Splenic Artery Embolization to Treat Portal Hypertension

Partial Splenic Artery Embolization to Treat Portal Hypertension

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Acesso radial distal guiado por ultrassonografia para intervenções transarteriais abdominopélvicas

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