Retrospective Comparison of Clinical Outcomes Following Splenic Vein Stenting and Splenic Arterial Embolization in Sinistral Portal Hypertension–Related Gastrointestinal Bleeding

Wei, Bo; Zhang, Linhao; Tong, Huan; Wang, Zhidong; Wu, Hao

doi:10.2214/ajr.20.23859

Cited by 26 publications

(36 citation statements)

References 23 publications

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“…Splenectomy is the historical treatment of SPH-related GIB, although SVS and SAE have been advocated as possible life-saving alternatives (Wei et al 2020;Fernandes et al 2015). Post-splenectomy sepsis from asplenia carries a reported mortality rate as high as 6% (Loftus et al 1993).…”

Section: Discussionmentioning

confidence: 99%

“…Six of these patients were identified as having splenic vein stenosis, and technical success was achieved in each case (Luo et al 2014). A recent retrospective comparative study between SAE and SVS for SPH-related GIB showed patients treated with SVS were less likely to develop rebleeding, with rebleeding rates of 7.1% and 47.8% in SVS versus SAE groups respectively (Wei et al 2020). The literature regarding SVS for SPH-related ascites is less robust, with few studies describing treatment with PVS rather than SVS (Tsauo et al 2016;Poo et al 2018;Maleux et al 2003;Stein and Link 1999).…”

Section: Discussionmentioning

confidence: 99%

“…While no long-term patency studies of SVS for SPHrelated chylous ascites are reported in the literature, comparisons may be tentatively drawn from splenic vein patency rates in SPH-related GIB. Wei et al (2020) reported a cumulative stent patency rate of 92.9% 12 months after SVS for SPH-related GIB. A single splenic stent dysfunction was their only SVS-related complication (Wei et al 2020).…”

Section: Discussionmentioning

confidence: 99%

“…Wei et al (2020) reported a cumulative stent patency rate of 92.9% 12 months after SVS for SPH-related GIB. A single splenic stent dysfunction was their only SVS-related complication (Wei et al 2020). Both cases of PVS for chylous ascites in the literature reported portal venous patency at 1 year.…”

Section: Discussionmentioning

confidence: 99%

“…Although SPH-related chylous ascites is rare, several cases describe successful treatment with portal venous recanalization (Tsauo et al 2016;Poo et al 2018;Maleux et al 2003). Splenectomy is effective in the treatment of SPH-related GIB, although recent studies have evaluated splenic vein stenting (SVS) and splenic arterial embolization (SAE) as minimally-invasive treatment alternatives (Ghelfi et al 2016;Luo et al 2014;Stein and Link 1999;Wei et al 2020). Herein, a case of SPH-related recurrent chylous ascites successfully treated with SVS is described.…”

Section: Introductionmentioning

confidence: 99%

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Splenic vein stenting for recurrent chylous ascites in sinistral portal hypertension: a case report

2021

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Background Sinistral portal hypertension results from obstruction or stenosis of the splenic vein and is characterized by normal portal vein pressures and liver function tests. Gastrointestinal bleeding is the most common presentation and indication for treatment. Although sinistral portal hypertension-related chylous ascites is rare, several cases have described successful treatment with portal venous, rather than splenic venous, recanalization. Splenectomy is effective in the treatment of sinistral portal hypertension-related bleeding, although recent studies have evaluated splenic vein stenting and splenic arterial embolization as minimally-invasive treatment alternatives. Splenic vein stenting may be a viable option for other presentations of sinistral portal hypertension. Case presentation A 59-year-old gentleman with a history of necrotizing gallstone pancreatitis was referred to interventional radiology for management of recurrent chylous ascites. Analysis of ascites demonstrated a triglyceride level of 1294 mg/dL. Computed tomography revealed splenic and superior mesenteric venous stricture. The patient elected to undergo minimally invasive transhepatic portal venography, which confirmed the presence of splenic vein and superior mesenteric vein stenosis. Venography of the splenic vein showed reversal of portal venous flow, multiple collaterals, and a pressure gradient of 14 mmHg. Two 10 mm × 40 mm Cordis stents were placed, which decreased the pressure gradient to 7 mmHg and resolved the portosystemic collaterals. At 6 months follow-up, the patient had no recurrent episodes of ascites. Conclusion The current case highlights the successful treatment of sinistral portal hypertension-related intractable chylous ascites treated with transhepatic splenic vein stenting. Splenic venous stent patency rates of 92.9% at 12 months have been reported. Rebleeding rates of 7.1% for splenic vein stenting, 16% for splenectomy, and 47.8% for splenic arterial embolization have been reported in the treatment of sinistral portal hypertension-related gastrointestinal bleeding. The literature regarding splenic vein stenting for sinistral portal hypertension-related ascites is less robust. Technical and clinical success in the current case suggests that splenic vein recanalization may be a safe and viable option in other sinistral portal hypertension-related symptomatology. Level of Evidence: Level 4, Case Report.

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Section: Discussionmentioning

confidence: 99%