Splenic artery embolization with detachable balloons for hypersplenism

Pang, Xiaoxi; Li, Tengyu; Wang, Chengen

doi:10.1177/0300060518786419

Cited by 11 publications

(11 citation statements)

References 23 publications

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“…3 Many studies demonstrated that the SAE was very effective for cirrhotic patients, as shown by increased peripheral blood cell counts. [4][5][6] However, few studies focused on the severe complications after SAE. In this study, we reported 16 patients with severe post-SAE complications, and discussed their symptoms, therapies and prognoses.…”

Section: Introductionmentioning

confidence: 99%

<p>Severe Complications After Splenic Artery Embolization for Portal Hypertension Due to Hepatic Cirrhosis</p>

Zhang¹,

Zhang²,

Long³

et al. 2020

RMHP

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Background: Splenomegaly/hypersplenism is one of the most common complications of portal hypertension. Splenic artery embolization (SAE) has been increasingly used for treatment of splenomegaly/hypersplenism. However, few studies focused on the severe complications after embolization. In this paper, we reported 16 cases of severe complications after SAE for portal hypertension. Methods: From February 2011 to January 2019, 16 cirrhotic patients were diagnosed with severe complications after embolization. The clinical symptoms, therapies and prognosis were analyzed. Results: In these patients, the splenic embolization volume was between 50% and 70%. Among 16 cases, 7 patients were diagnosed with splenic abscess and/or left subphrenic abscess, suffered from the insistent fever, and eventually underwent the surgical therapy; 6 patients with left refractory pleural effusion, suffered from severe chest distress, and underwent repeated thoracocentesis or thoracic closed drainage; 3 patients with thrombosis in portal vein needed oral warfarin therapy. Conclusion: In cirrhotic patients, the severe complications after SAE are not uncommon after the procedure. It causes more suffering, prolonged hospital stay and more medical cost in these patients. It was debatable whether this technique was an appropriate technique for portal hypertension due to liver cirrhosis, patients contraindicated for the treatment should be carefully identified to avoid the complications.

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Section: Introductionmentioning

confidence: 99%

<p>Severe Complications After Splenic Artery Embolization for Portal Hypertension Due to Hepatic Cirrhosis</p>

Zhang¹,

Zhang²,

Long³

et al. 2020

RMHP

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“…Numata et al [ 54 ] reported that PSE was also effective in improving liver function status in cirrhotic patients with hypersplenism. It is found by Pang et al [ 55 ] that total bilirubin levels decreased in patients after PSE and returned to normal levels after 6 months. Hayashi et al [ 56 ] found that 1 year after PSE, patients' serum albumin and cholinesterase increased to 104 ± 14% and 130 ± 65% of pretreatment levels, respectively.…”

Section: Discussionmentioning

confidence: 97%

Efficacy and safety of heparin plus dexamethasone after partial splenic embolization for liver cirrhosis with massive splenomegaly

Zheng

Xiong

et al. 2022

BMC Gastroenterol

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Purpose The aim of this study was to investigate the efficacy and safety of the combination of low-molecular-weight heparin + dexamethasone after partial splenic embolization in cirrhotic patients with massive splenomegaly. Methods This study included 116 patients with liver cirrhosis complicated with massive splenomegaly who underwent PSE in Union Hospital from January 2016 to December 2019, and they met the criteria. They were divided into two groups: PSE + Hep + Dex group (N = 54) and PSE group (N = 62). We conducted a retrospective study to analyze the efficacy and safety of the two groups of patients. Results The volume of splenic embolization was 622.34 ± 157.06 cm3 in the PSE + Hep + DEX group and 587.62 ± 175.33 cm3 in the PSE group (P = 0.306). There was no statistically difference in the embolization rate of the spleen between the two groups (P = 0.573). WBC peaked 1 week after PSE and PLT peaked 1 month after PSE in both groups; it gradually decreased later, but was significantly higher than the preoperative level during the 12-month follow-up period. The incidences of abdominal pain (46.3% vs 66.1%, P = 0.039), fever (38.9% vs 75.8%, P < 0.001), PVT (1.9% vs 12.9%, P = 0.026), refractory ascites (5.6% vs 19.4%, P = 0.027) were lower in the PSE + Hep + DEX group than in the PSE group. The VAS score of abdominal pain in PSE group was higher than that in PSE + Hep + DEX group on postoperative days 2–8 (P < 0.05). Splenic abscess occurred in 1(1.6%) patient in the PSE group and none (0.0%) in the PSE + Hep + DEX group (P = 0.349). Conclusions The combined use of dexamethasone and low-molecular-weight heparin after PSE is a safe and effective treatment strategy that can significantly reduce the incidence of complications after PSE (such as post-embolization syndrome, PVT, refractory ascites).

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“…The major findings from this review included an increase in hemoglobin, leukocytes, and thrombocytes 2 4 7 8 9 11 12 13 as well as a reduction in spleen volume, 2 7 8 12 hepatic wedge venous pressure, 6 9 portal venous blood flow and portosystemic shunt pressure, 8 10 and gastroesophageal varices 2 4 6 7 9 10 after PSE. While Waguri et al 10 reported an improvement in liver function tests after PSE, Ozturk et al 11 and Pålsson et al 4 did not find a significant change.…”

Section: Resultsmentioning

confidence: 93%

Partial Splenic Artery Embolization to Treat Portal Hypertension

Srinivas

Yeluru

Berman

et al. 2022

Digestive Disease Interventions

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Portal hypertension (PH) commonly occurs in the setting of underlying liver disease and can precipitate variceal bleeding and ascites among other complications. Traditionally, PH is managed with medication or lifestyle changes with refractory cases treated with transjugular intrahepatic portosystemic shunts or splenectomy. Partial splenic artery embolization (PSE) is an alternative treatment which may reduce PH by decreasing splenic vein inflow into the portal vein. In this article, we review the efficacy of PSE and present illustrative cases with a focus on technical and clinical considerations for embolization. We queried the PubMed database from August 1976 to September 2021 for clinical studies of PSE for the treatment of portal hypertension. For each article, the author, year, title, study design, number of patients, age, sex, liver function, technical considerations, adverse effects, and outcomes were recorded. We also review two successful and unsuccessful cases from our institution. A total of 12 studies were identified with 258 patients undergoing 290 PSE treatments. The mean age of patients was 44.1 years (range: 6–77). Most patients had well-compensated liver disease (Child–Pugh (CP) A; 35.1%) or significant functional compromise (CP-B; 44.4%), but a few had decompensated disease (CP-C; 8.9%). The majority (91.7%) of procedures were performed distally within the splenic artery, and on average, 59.5% (20–100) of the spleen underwent infarction. Common complications included symptoms of postembolization syndrome such as abdominal pain (58.5%) and fever (53.2%) as well as atelectasis (9.0%). Five PSE procedures (1.7%) resulted in death secondary to pleuropneumonia, splenic abscess, sepsis, intracranial hemorrhage, and pulmonary embolism, respectively. PSE is an effective but often underutilized treatment for PH. These benefits have risk for minor complications including postembolization syndrome and major complications such as splenic abscess formation. This article will introduce the reader to important technical and clinical considerations regarding PSE.

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Splenic artery embolization with detachable balloons for hypersplenism

Cited by 11 publications

References 23 publications

<p>Severe Complications After Splenic Artery Embolization for Portal Hypertension Due to Hepatic Cirrhosis</p>

<p>Severe Complications After Splenic Artery Embolization for Portal Hypertension Due to Hepatic Cirrhosis</p>

Efficacy and safety of heparin plus dexamethasone after partial splenic embolization for liver cirrhosis with massive splenomegaly

Partial Splenic Artery Embolization to Treat Portal Hypertension

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