Portal and splanchnic hemodynamics after partial splenic embolization in cirrhotic patients with hypersplenism

Abstract

To assess the acute effects of partial splenic embolization (PSE) on portal and splanchnic hemodynamics in patients with cirrhosis. Ninety-five patients with hypersplenism were included in the study. Duplex examinations were performed before and 3 and 7 days after PSE. Portal and splanchnic hemodynamics including vessel cross-sectional area (CSA), mean flow velocities (cm/s), blood flows (mL/min), Doppler indices as portal congestion index (CI), liver vascular index, hepatic artery and superior mesenteric artery (SMA) pulsatility and resistive indices (PI and RI), were performed before and after PSE. In our study, 69 of 95 patients were males (72.6%) and 26 females (27.3%). Chronic hepatitis C virus infection was the main cause of cirrhosis (81.1%). PSE failed technically in six patients (6.3%). After PSE, both CSA and CI significantly decreased (p < 0.05 and <0.01). The portal vein velocity significantly increased (p < 0.01). The portal flow volume (892.4 ± 151 mL/min) did not show significant changes. The hepatic artery RI and PI showed a steady increase that became significant 7 days post-PSE (p < 0.05). The RI and PI of SMA increased significantly after 7 days of PSE (p < 0.05). PSE has an immediate portal decompression effect in patients with portal hypertension without reduction in portal flow. This effect on portal pressure should be investigated in future studies as a potential tool for management of acute variceal bleeding when other medical procedures fail.

The Association between Platelet count and Liver volume after eradication of Hepatitis C virus by Direct-acting Antivirals: a retrospective study

“…However, change in spleen volume was significantly correlated with change in serum albumin level. Studies have shown that reduction in spleen volume by PSE reduced portal pressure and flow in the splenic vein, but maintained portal perfusion [18][19][20]. These studies suggest that reduction in splenic arterial flow caused significant reduction in splenic venous flow with minimal decrease in the portal vein flow volume, while the flow of the superior mesenteric vein increased.…”

Significant improvement in portal‐systemic liver failure symptoms and successful management of portal‐splenic venous hemodynamics by the combination of interventional radiology and pharmacotherapy

“…Some previous studies have demonstrated the precise effect of PSE in PVP reduction. 24,25 In addition, clinical trials have shown that endoscopic and endovascular therapies combined with PSE significantly reduced the rate of esophagogastric variceal bleeding and recurrence. 20,26,27 Moreover, splenic artery embolization for patients with cirrhosis and hypersplenism has been reported to improve functional parameters of the liver.…”

Treatment of Refractory Stomal Variceal Hemorrhage with Partial Splenic Artery Embolization: A Case Report

“…PSE is used to improve liver function, reduce variceal bleeding, treat hepatic encephalopathy, and improve blood cell counts in patients with portal hypertension [7]. In addition, PSE can increase platelet count in patients with hypersplenism from idiopathic thrombocytopenic purpura, thalassemia, idiopathic hypersplenism, and cytopenia caused by anticancer chemotherapy [7][8][9][10]. The improved liver function observed in patients with cirrhosis following PSE is likely related to increased blood flow in the hepatic arterial and superior mesenteric vein [8].…”

“…In addition, PSE can increase platelet count in patients with hypersplenism from idiopathic thrombocytopenic purpura, thalassemia, idiopathic hypersplenism, and cytopenia caused by anticancer chemotherapy [7][8][9][10]. The improved liver function observed in patients with cirrhosis following PSE is likely related to increased blood flow in the hepatic arterial and superior mesenteric vein [8]. PSE can arrest variceal bleeding as a result of decreased splenic venous flow into the portal venous system, leading to reduction in mesenteric and colonic venous pressures.…”

“…Helaly et al investigated the acute effects of PSE on portal and splanchnic hemodynamics in patients with cirrhosis using duplex examinations. They concluded that PSE has an immediate portal decompression effect on patients with portal hypertension without reducing portal flow [8].…”