Partial splenic embolization through endoscopic ultrasound-guided implantation of coil as a potential technique to treat portal hypertension

Chen, Qian; Li, Zhen; Yang, Yang; Wei, Yan; Cheng, Bin; Yuan, Yue; Zhang, Zhengang

doi:10.1055/a-1174-5590

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…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. 64 In addition, recent developments in embolics, such as Guglielmi detachable coils, have allowed accurate delivery of PSE with less coils compared with conventional metallic coils.…”

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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“…Anatomically, the splenic artery is near to the gastric wall and is easily visualized by endoscopic ultrasound (EUS). Transgastric puncture of the splenic artery provides the shortest surgical route and does not require radiographic assistance, which led Chen and colleagues to propose endoscopic ultrasound-guided partial splenic embolization (EUS-PSE); they also conducted preliminary research into the prevention of variceal bleeding 2 3 . Recently, we successfully performed EUS-PSE for the treatment of hypersplenism.…”

Section: Figmentioning

confidence: 99%

Endoscopic ultrasound-guided partial splenic embolization for hypersplenism: a novel alternative

Liu,

Zhu,

Cao

et al. 2024

Endoscopy

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“…A combination of PSE and endoscopic therapy tends to further decrease the risk of variceal bleeding 2 . The authors have focused on enhancing the safety of endoscopic-ultrasound (EUS)-guided PSE 3 through super-selection and controlled embolization of the lower pole branch of the splenic artery and its supply area, utilization of a thinner needle, and double validation of the punctured artery. The delivery process of embolic material has been simplified as well ( Video 1 ).…”

Section: Figmentioning

confidence: 99%