Role of Splenic Artery Embolization in Gastric Variceal Hemorrhage due to Sinistral Portal Hypertension

Sebastian, Bibin; Singhal, Soumil; Madhurkar, Rohit; Alex, Arun; Uthappa, Mangerira

doi:10.1055/s-0038-1675858

Cited by 6 publications

(12 citation statements)

References 44 publications

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“…Our patient's bleeding was controlled with SAE which was used to block direct arterial inflow to the spleen, and thereby reduce the outflow venous pressure that results in gastric varices [5]. Alternative therapies include endovascular stents, splenectomy, and vascular surgery for patients who are good surgical candidates [6,7].…”

Section: Discussionmentioning

confidence: 99%

Isolated Gastric Variceal Hemorrhage Secondary to Idiopathic Sinistral Portal Hypertension

Abraham¹,

Doshi²,

Asfari³

et al. 2021

Cureus

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Sinistral portal hypertension (SPH), also known as left-sided portal hypertension or segmental portal hypertension, is a rare cause of upper gastrointestinal bleeding. Historically, SPH is a result of obstruction of the splenic vein often secondary to pancreatic pathology. To our knowledge, there are no reported cases of idiopathic SPH in which the findings cannot be attributed to any etiology. It is important to do a detailed workup to rule out common pathologies of SPH before making a diagnosis of idiopathic SPH. Treatment of gastric variceal bleed secondary to idiopathic SPH can be challenging and requires a multidisciplinary approach with surgery and interventional radiology. Our patient's history, examination findings, and imaging revealed no identifiable cause for SPH suggesting idiopathic SPH. We describe a case of isolated gastric variceal hemorrhage due to idiopathic SPH that was successfully treated.

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Section: Discussionmentioning

confidence: 99%

Isolated Gastric Variceal Hemorrhage Secondary to Idiopathic Sinistral Portal Hypertension

Abraham¹,

Doshi²,

Asfari³

et al. 2021

Cureus

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“…In some SPH patients, esophageal and gastric varices are completely excised. In our case, the stomach (a) and esophagus (b) are presented free of varices ultrasonography (US) is a more useful diagnostic tool for exclusion of systemic portal hypertension by excluding hepatic cirrhosis [18]. Endoscopic US is compared to US the superior imaging modality in evaluating the SV [11].…”

Section: Pathophysiology Of Sphmentioning

confidence: 99%

Management of Sinistral Portal Hypertension after Pancreaticoduodenectomy

Mansour,

Sirtl,

Angele

et al. 2024

Dig Dis

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Background: Sinistral or left-sided portal hypertension (SPH) is a rare cause of upper gastrointestinal hemorrhage resulting from obstruction of the splenic vein. Venous drainage from the spleen via collaterals can result in venous hemorrhage both into the retroperitoneal and intraabdominal space due to increased venous blood pressure in peripancreatic and gastroduodenal vasculature. SPH can occur secondary to pancreatitis with thrombosis of the splenic vein. Another possible cause is the surgical ligation of the splenic vein as part of pancreaticoduodenectomy (PD). Although splenectomy has been traditionally considered as the treatment of choice to relieve venous hypertension, individual concepts for each patient have to be developed. Considering the venous collateral drainage pathways, a comprehensive approach involving surgical, endoscopic, and interventional radiology interventions may be necessary to address the underlying cause of variceal bleeding. Among these approaches, splenic artery embolization (SAE) has demonstrated efficacy in mitigating the adverse effects associated with elevated venous outflow pressure. Summary: This review summarizes key imaging findings in SPH patients after pancreaticoduodenectomy and highlights the potential of minimally invasive embolization for curative treatment of variceal hemorrhage. Key Messages: • sinistral portal hypertension is a potential consequence after major pancreas surgery • collateral flow can lead to life threatening abdominal bleeding • depending on the origin and localization of the bleeding a dedicated management is required, frequently involving interventional radiology techniques

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“…[66] The low viscosity of NBCA allows the distal delivery through the microcatheter and realizes the immediate occlusion of small arteries and collateral circulations, which is advantageous than particulate embolic agents and Reproduced with permission. [52] Copyright 2019, Thieme Medical Publishers. B) Aneurysm.…”

Section: Hemorrhagementioning

confidence: 99%

mentioning

confidence: 99%

Recent Progress in Advanced Hydrogel‐Based Embolic Agents: From Rational Design Strategies to Improved Endovascular Embolization

Ullah

et al. 2023

Adv Healthcare Materials

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Transcatheter arterial embolization, a minimally invasive treatment to deliberately occlude the blood vessels, has become a safe and effective procedure for the management of vascular diseases and benign/malignant tumors. Particularly, hydrogel‐based embolic agents have garnered much attention because of their potential to address some of the limitations of clinically used embolic agents and can be rationally designed to impart more favorable characteristics or functions. In this review, the recent progress toward the development of polymer‐based hydrogels for effective endovascular embolization, including the in situ gelling hydrogels mediated by physically or chemically crosslinking, imageable hydrogels for intraprocedural and postprocedural feedback, use of hydrogels as the drug depot for local delivery of therapeutic drugs, hemostatic hydrogels inducing extrinsic or intrinsic coagulation of blood, stimuli‐responsive shape memory hydrogels as the smart embolization devices, and hydrogels incorporating external‐stimuli functional materials for multidisciplinary therapy, is systemically summarized. Moreover, the potential considerations of hydrogel‐based embolic agents confronted in therapeutic embolization are pointed out. Finally, the perspectives for the development of more effective embolic hydrogels are also highlighted.

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Role of Splenic Artery Embolization in Gastric Variceal Hemorrhage due to Sinistral Portal Hypertension

Cited by 6 publications

References 44 publications

Isolated Gastric Variceal Hemorrhage Secondary to Idiopathic Sinistral Portal Hypertension

Isolated Gastric Variceal Hemorrhage Secondary to Idiopathic Sinistral Portal Hypertension

Management of Sinistral Portal Hypertension after Pancreaticoduodenectomy

Recent Progress in Advanced Hydrogel‐Based Embolic Agents: From Rational Design Strategies to Improved Endovascular Embolization

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