Splenic artery embolization: a single center review of safety, efficacy, and clinical outcomes

Gaba, Ron C.; Katz, Jeremy; Parvinian, Ahmad; Reich, Steven D.; Omene, Benedictta O.; Yap, Felix Y.; Owens, Charles; Knuttinen, M-Grace; Bui, James T.

doi:10.4261/1305-3825.dir.5895-12.1

Cited by 24 publications

(27 citation statements)

References 32 publications

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“…However, most of these complications are minor and include symptoms of fever, leukocytosis, abdominal pain, and hydrothorax. More severe complications are rare, including splenic abscesses and splenic infarction [14, 15]. Our patient was able to undergo successful treatment with splenic artery embolization, thus avoiding the potential risks of surgery, and had cessation of his variceal bleeding.…”

Section: Discussionmentioning

confidence: 84%

“…Splenic artery embolization has been shown to be as effective as splenectomy in lowering portal pressure and avoids potential complications of postsplenectomy sepsis or unregulated thrombocytosis. Studies have reported that the overall complication rate of splenic artery embolization is around 33–52% [14, 15]. However, most of these complications are minor and include symptoms of fever, leukocytosis, abdominal pain, and hydrothorax.…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Gastric Variceal Hemorrhage Secondary to Infiltrative B-Cell Lymphoma

Lenhart

Fernandez-Castillo

Mullins

et al. 2016

Case Rep Gastroenterol

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Portal hypertension commonly arises in the setting of advanced liver cirrhosis and is the consequence of increased resistance within the portal vasculature. Less commonly, left-sided noncirrhotic portal hypertension can develop in a patient secondary to isolated obstruction of the splenic vein. We present a rare case of left-sided portal hypertension and isolated gastric varices in a patient with large B-cell lymphoma, who was treated with splenic artery embolization. The patient is a 73-year-old male with no previous history of liver disease, who presented with coffee ground emesis and melena. On admission to hospital, he was found to have a hemoglobin level of 3.4 g/l. Emergent esophagogastroduodenoscopy showed isolated bleeding gastric varices (IGV1 by Sarin classification) in the fundus and cardia with subsequent argon plasma coagulation injection. He was transferred to our tertiary center where work-up revealed normal liver function tests, and abdominal ultrasound showed patent hepatic/portal vasculature without cirrhosis. MRI demonstrated a large heterogeneously enhancing mass in the pancreatic tail, with invasion into the spleen and associated splenic vein thrombosis. Surgery consultation was obtained, but urgent splenectomy was not recommended. The patient instead underwent splenic artery embolization to prevent future bleeding from his known gastric varices. Pathology from a CT-guided biopsy was consistent with diffuse large B-cell lymphoma. PET imaging showed uptake in the splenic hilum/pancreatic tail region with no additional metastatic involvement. He was evaluated by the Hematology Department to initiate R-CHOP chemotherapy. During his outpatient follow-up, he reported no further episodes of melena or hematemesis. To the best of our knowledge, there have only been two published case reports of large B-cell lymphoma causing upper gastrointestinal bleeding from isolated gastric varices. These cases were treated with splenectomy or chemotherapy alone. Thus far, splenectomy has been the standard treatment approach for splenic vein thrombosis with clinical complication, such as gastric variceal bleeding. We present a case of successful treatment of bleeding isolated gastric varices using a less invasive and less morbid approach through splenic artery embolization. This case highlights the need for an increased awareness of the diverse etiologies of left-sided portal hypertension and isolated gastric varices, as well as the consideration of minimally invasive management strategies.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

A Rare Case of Gastric Variceal Hemorrhage Secondary to Infiltrative B-Cell Lymphoma

Lenhart

Fernandez-Castillo

Mullins

et al. 2016

Case Rep Gastroenterol

View full text Add to dashboard Cite

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“…One mechanism for the introduction of bacteria may be the use of room air to create the gelfoam slurry. These findings are statistically significant, and suggest the utility of a large randomized controlled trial to further characterize this relationship (1)(2)(3)(4)(5).…”

Section: Scientific Session 24mentioning

confidence: 74%

Perisplenic abscess formation after splenic artery embolization with gelfoam versus coil embolization

Hayes

Laroia

Becker

et al. 2016

Journal of Vascular and Interventional Radiology

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“…Koconis et al (2007) reported that partial splenic embolization made efficacious improvements on the bleeding and hematologic parameters for partial hypertension patients, and the associated morbidity and mortality were acceptable. Petermann et al (2012) and Gaba et al (2013) both reported that the overall observed complication rate was around 33%-52%. However, since most of the complications included fever, leukocytosis, abdominal pain, and hydrothorax which have no clinical consequence, we believe that they are best classified as side effects (rather than complications).…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review

et al. 2013

J. Zhejiang Univ. Sci. B

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Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic. In cases where gastrointestinal (GI) bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article. The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography. After embolization, the bleeding stopped and stabilized for the entire follow-up period without any severe complications. In conclusion, embolization of the splenic artery is a simple, safe, and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

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Splenic artery embolization: a single center review of safety, efficacy, and clinical outcomes

Abstract: SAE was performed with high technical success and efficacy, but the outcomes showed nontrivial morbidity rates. Elderly patients with thrombocytopenia and hydrothorax after SAE, and patients who require secondary interventions, should be monitored for complications.

Cited by 24 publications

References 32 publications

A Rare Case of Gastric Variceal Hemorrhage Secondary to Infiltrative B-Cell Lymphoma

A Rare Case of Gastric Variceal Hemorrhage Secondary to Infiltrative B-Cell Lymphoma

Perisplenic abscess formation after splenic artery embolization with gelfoam versus coil embolization

Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review

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