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

Kim, Hee Joon; Park, Eun Kyu; Hur, Young Hoe; Koh, Yang Seok; Cho, Chol Kyoon

doi:10.1155/2016/1585926

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…Vascular plugs can also be used at the distal splenic artery proximal to branching of hilar vessels [33]. Agents like lipiodol and absolute alcohol offer cheaper and readily available alternatives [31].…”

Section: Surgical Treatmentmentioning

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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Section: Surgical Treatmentmentioning

confidence: 99%

Management of Sinistral Portal Hypertension after Pancreaticoduodenectomy

Mansour,

Sirtl,

Angele

et al. 2024

Dig Dis

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“…posterior or short gastric vein) instead of the outflow shunt or IR guided coil embolization; these endovascular therapies are often performed in conjunction with the more commonly performed procedures, including TIPS combined with BRTO to maximize likelihood of successful variceal treatment. Lastly, splenic artery embolization can be considered for patients with isolated splenic venous thrombosis, especially when surgery may be too high risk and BRTO is not feasible [36].…”

Section: Endovascular Treatmentmentioning

confidence: 99%

Gastric varices

Wang,

Ryou

2023

Current Opinion in Gastroenterology

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Purpose of review Gastric varices are a rare cause of gastrointestinal bleeding in patients with portal hypertension. There have been significantly advances within endoscopic ultrasound for treatment of gastric varices over the past 5 years in addition to the conventional endoscopic and endovascular therapies. In this review, we will review the latest literature on gastric varices with emphasis on changes to the conventional classification systems and comparisons among the different treatment options for gastric varices in terms of efficacy and safety. Recent findings There have been new guidelines proposed by the American Gastrointestinal Association on a simpler classification system compared to the conventional Sarin classification. In addition, endoscopic ultrasound guided coil embolization, a novel treatment pioneered over the past 5 years for gastric varices, has shown increased efficacy and reduced adverse event profile compared to cyanoacrylate glue, the more traditional therapy for gastric variceal bleeding. Options for endovascular therapy overall have not significantly changed over the recent years. Summary Based on our literature review, we recommend a step-up approach with initial medical and endoscopic management with consideration of endovascular therapies when initial therapies fail.

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“…39 Vascular plugs can also be used at the distal splenic artery just proximal to branching of hilar vessels. 40 Agents like absolute alcohol and lipiodol are cheaper and readily available alternatives. 28 Silk suture material (4-0 or 5-0) cut in 2-mm length have also been used as embolic agent.…”

Section: Embolization Agentsmentioning

confidence: 99%

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

Sebastian

Singhal

Madhurkar

et al. 2018

J Clin Interv Radiol ISVIR

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Sinistral or left-sided portal hypertension is a localized form of portal hypertension usually due to isolated obstruction of splenic vein. Most commonly, it is secondary to pancreatitis. Rarely this can present as life-threatening gastric variceal bleeding. In such patients, splenectomy is traditionally considered as the treatment of choice to relieve venous hypertension. Unfortunately, a surgical operation may not be safe in most of the patients because of the unfavorable operative field. Splenic artery embolization (SAE) is an effective method, theoretically akin to splenectomy, blocking the direct arterial inflow to the spleen and thereby reducing the outflow venous pressure. The authors demonstrate a case of a 58-year-old man who presented with severe gastric variceal hemorrhage due to sinistral portal hypertension (SPH) secondary to an episode of pancreatitis, which he had 1 month back. He was successfully managed by SAE and remains symptom-free. The authors bring to the fore the potential curability of gastric variceal hemorrhage secondary to SPH using SAE, which is a safe and effective interventional radiologic procedure.

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

Cited by 4 publications

References 10 publications

Management of Sinistral Portal Hypertension after Pancreaticoduodenectomy

Management of Sinistral Portal Hypertension after Pancreaticoduodenectomy

Gastric varices

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

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