Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization

Sankararaman, Senthilkumar; Velayuthan, Sujithra; Vea, Romulo; Herbst, John J.

doi:10.1111/ped.12014

Cited by 15 publications

(12 citation statements)

References 12 publications

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“…Consistent with these studies, variceal bleeding in our study decreased significantly in all patients receiving TIPS. Despite PSE being reported as efficacious in reducing variceal bleeding [8] by reducing portal venous flow and pressure, combined therapy using TIPS and PSE in our study did not achieve significantly more reduced variceal bleeding compared to that of patients receiving TIPS alone, which might be related to the already very low bleeding frequencies obtained by creation of TIPS.…”

Section: Discussioncontrasting

confidence: 88%

“…PSE was also carried out by the same interventional radiologists, according to the method described in previous studies [8,15] . During the procedure, a 5.0-F RH or Yashiro catheter (Terumo, Tokyo, Japan) was used to demonstrate the distribution of splenic arteries and collateral circulation routes, and spring coils(18-6/2mm, 18-10/4mm, Cook Inc., Bloomington, IN, USA) were used to embolize branches of the splenic arteries with a splenic infarction ratio set at below 50% ( Figure 2B).…”

Section: Pse Proceduresmentioning

confidence: 99%

“…Risk factors for recurrent bleeding include an insufficient decrease in portosystemic pressure gradient after TIPS creation alone [4] . Partial splenic arterial embolization(PSE), which has been an established interventional approach for portal hypersplenism [5,6] , appears to be efficatious to in reducing episodes of variceal bleeding [7,8] , improving hematologic parameters [9,10] , enhancing hepatic protein synthesis [11] , and reducing severity of HE [12] .…”

Section: Introductionmentioning

confidence: 99%

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Simultaneous Combined Transjugular Intrahepatic Portosystemic Shunt and Partial Splenic Embolization for Decompensated Cirrhosis

Wan

Yang

et al. 2016

Journal of Gastroenterology and Hepatology Research

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AIM:To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in combination with partial splenic arterial embolization (PSE) for cirrhotic patients with recurrent variceal bleeding and hypersplenism. METHODS: Institutional review board approval was obtained; all patients provided informed consent. From January 2010 to December 2014, a total of 141 cirrhotic patients received TIPS alone(group A, n=114) and simultaneous combined TIPS and PSE(group B, n=27) for recurrent variceal bleeding and hypersplenism secondary to portal hypertension. The TIPS was created by using covered stents. All patients underwent embolotherapy via the jugular vein after TIPS implantation. Patients in group B (n=27) received simultaneous PSE after creation of TIPS. Biochemical tests, coagulation function, complete blood cell (CBC) counts, frequencies of recurrent variceal bleeding and hepatic encephalopathy (HE), and survival were evaluated. Model for end stage liver diseases (MELD) scores were calculated. RESULTS: TIPS creation was successful in all patients. After the treatments, patients in group B had better hepatic synthetic function, increased levels of white blood cells (WBC), platelets (PLT), and hemoglobin(HGB), lower frequency of HE, lower overall and cirrhosis-related mortality than patients in group A (P<0.05), though the two groups had similar recurrent variceal bleeding frequency (P>0.05). Multivariate analysis showed that MELD scores, HE, and group were independent factors for overall and liver-related mortality at month 24 (P<0.05). No severe complications were observed in the two groups. CONCLUSIONS: Simultaneous combined TIPS and PSE regimen improves hematologic parameters, prevents deterioration of liver function and coagulation function, reduces variceal bleeding and HE, thus reduces mortality.

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Section: Discussioncontrasting

confidence: 88%

Section: Pse Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simultaneous Combined Transjugular Intrahepatic Portosystemic Shunt and Partial Splenic Embolization for Decompensated Cirrhosis

Wan

Yang

et al. 2016

Journal of Gastroenterology and Hepatology Research

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“…By contrast, Sankararaman et al planned to embolize 80~90% of the spleen. After selective SAE, huge area of spleen was infarcted [6]. In our case, we performed nonselective SAE; then only small portion of spleen was infarcted.…”

Section: Discussionmentioning

confidence: 92%

“…Some authors have reported that splenic artery embolization (SAE) is an effective alternative to splenectomy for the treatment of gastric variceal bleeding with left-sided portal hypertension [2, 5, 6]. …”

Section: Introductionmentioning

confidence: 99%

Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

Kim

Park

Hur

et al. 2016

Case Reports in Medicine

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Splenic vein thrombosis is a relatively common finding in pancreatitis. Gastric variceal bleeding is a life-threatening complication of splenic vein thrombosis, resulting from increased blood flow to short gastric vein. Traditionally, splenectomy is considered the treatment of choice. However, surgery in necrotizing pancreatitis is dangerous, because of severe inflammation, adhesion, and bleeding tendency. In the Warshaw operation, gastric variceal bleeding is rare, even though splenic vein is resected. Because the splenic artery is also resected, blood flow to short gastric vein is not increased problematically. Herein, we report a case of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis successfully treated with splenic artery embolization. Splenic artery embolization could be the best treatment option for gastric variceal bleeding when splenectomy is difficult such as in case associated with severe acute pancreatitis or associated with severe adhesion or in patients with high operation risk.

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Pediatric liver cirrhosis interventional procedures: from biopsy to transjugular intrahepatic portosystemic shunt

et al. 2022

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Cirrhosis is a complex diffuse process whereby the architecture of the liver is replaced by abnormal nodules because of the presence of fibrosis. Several pediatric diseases such as extrahepatic portal vein obstruction, biliary atresia, alpha-1-antitrypsin deficit and autoimmune hepatitis can lead to cirrhosis and portal hypertension in children. In this article the authors describe interventional radiology procedures that can facilitate the diagnosis and treatment of diseases associated with liver cirrhosis and portal hypertension in the pediatric population. These procedures include image-guided liver biopsy, mesenteric–intrahepatic left portal vein shunts, balloon-occluded retrograde transvenous obliteration, transjugular intrahepatic portosystemic shunts and splenic embolization.

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Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization

Cited by 15 publications

References 12 publications

Simultaneous Combined Transjugular Intrahepatic Portosystemic Shunt and Partial Splenic Embolization for Decompensated Cirrhosis

Simultaneous Combined Transjugular Intrahepatic Portosystemic Shunt and Partial Splenic Embolization for Decompensated Cirrhosis

Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

Pediatric liver cirrhosis interventional procedures: from biopsy to transjugular intrahepatic portosystemic shunt

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