Review articlePartial Splenic Embolization in the Treatment of Patients with Portal Hypertension: A Review of the English Language Literature
Section snippets
History of Splenic Embolization
In 1973, Maddison was the first to report the use of splenic embolization in a human being. Dr. Maddison successfully used autologous clot to embolize the spleen of an actively bleeding farmer who had suffered from repeated bouts of gastrointestinal hemorrhage from esophageal varices. In 5 months of follow-up, no further episodes of gastrointestinal bleeding occurred (3). For several years after Maddison’s abstract was published, many investigators attempted to use splenic embolization in the
Efficacy of Splenic Embolization for Variceal Hemmorhage
Though the underlying mechanism eludes current understanding, much evidence exists that splenic embolization is effective in treating variceal hemorrhage. Table 1 summarizes the findings of those authors who have studied this outcome. It includes results from articles published in the English-language literature since 1973 that look at variceal bleeding outcomes in patients treated with PSE or with a combination of PSE and endoscopic variceal ligation (EVL). Not included are study results in
Efficacy of Splenic Embolization in Improving Liver Function
Splenic embolization also appears to improve the hepatic protein synthetic capabilities of patients with portal hypertension. In 1986, Hirai et al noted improved liver function tests in a cirrhotic patient treated with PSE (75). Ten years later, two different studies looked at liver function in a total of 40 portal-hypertensive patients treated with PSE. These investigations found significantly improved values of cholinesterase, total cholesterol, total protein, albumin, and prothrombin time
Efficacy of Splenic Embolization in Improving Hematologic Parameters
The efficacy of splenic embolization for improving hematologic parameters is well established. Significant and durable improvements have been shown in leukocyte count (62, 80, 81), red blood cell count (61), and platelet count (61, 62, 79, 80, 81) after PSE. Increased leukocyte count after splenic embolization is likely due to decreased splenic pooling of white blood cells (82). Increased red blood cell count after splenic embolization appears to be attributable to increased erythrocyte
Efficacy of Splenic Embolization for Hepatic Encephalopathy
The literature also suggests that splenic embolization may play a role in improving hepatic encephalopathy. Yoshida et al demonstrated that use of PSE in conjunction with obliteration of portal-systemic shunts in patients with hepatic encephalopathy resulted in decreased serum ammonia levels and lower grades of encephalopathy when compared with patients who underwent shunt obliteration but did not have PSE (84). Additionally, Uflacker et al demonstrated control of hepatic encephalopathy in two
Survival
Very few studies of PSE in patients with portal hypertension have looked at survival as an outcome. Those that have found mixed results. In Ohmoto’s nonrandomized comparison of patients treated with PSE and EVL with those treated with EVL alone, the relative risk of death in the PSE/EVL group was 0.193 (95% CI 0.053–0.699; P = .012) (70). Figure 2 shows the survival curve from Ohmoto’s study. Additionally, work done by Tajiri et al, while not showing a statistically significant difference in
Morbidity and Mortality
Given that significant complications were common in the early history of PSE and that these complications were likely responsible for the technique’s failure to become a mainstream treatment option for patients with portal hypertension, it is important to take a close look at the complications associated with more recent use of PSE. As was discussed at the opening of this article, improvement in associated morbidity and mortality is not unexpected given 30 years worth of advancement in
Conclusions
Management of the complications of portal hypertension is a major challenge for clinicians. This is especially the case for those patients who suffer from recurrent bleeding of gastroesophageal varices. PSE, either by itself or in conjunction with other therapies, shows promise as a useful intervention for achieving control of variceal hemorrhage. Though no randomized control trials have been conducted to investigate the potential of this technique, numerous case reports, case series reports,
References (110)
- et al.
Correction of hypersplenism without splenectomy
J Pediatr Surg
(1981) - et al.
Splenic embolization in a child with hypersplenism
J Pediatr Surg
(1982) - et al.
Variceal hemorrhage in biliary atresia
J Pediatr Surg
(1984) - et al.
Giant iatrogenic pseudocyst
J Pediatr Surg
(1989) - et al.
Causes and management of portal hypertension in the pediatric population
Clin Liver Dis
(2001) Esophageal varices
Gastrointest Endosc Clin N Am
(1994)- et al.
Partial embolization of the spleen in patients with thalassemia
J Vasc Interv Radiol
(1995) - et al.
Partial splenic embolization in the management of hypersplenism secondary to Gaucher disease
J Pediatr
(1982) - et al.
Partial splenic embolization for hypersplenism after liver transplantation
Transplant Proc
(2001) - et al.
Preoperative embolization of the spleen in children with hypersplenism
J Vasc Interv Radiol
(1992)
Restoration of thrombopoietin production after partial splenic embolization leads to resolution of thrombocytopenia in liver cirrhosis
Hepatol Res
Long-term efficacy of partial splenic embolization in children
J Pediatr Surg
Partial splenic embolization in patients with idiopathic portal hypertension
Eur J Radiol
Partial splenic embolization in children with hypersplenism
J Pediatr
Splenic embolization in children: long-term efficacy
J Pediatr Surg
Comparison of two different percutaneous splenic artery interventions in the treatment of hypersplenism: preliminary report
Transplant Proc
Severe complications from partial splenic embolization in patients with liver failure
Br J Radiol
Blunt splenic injuries: high non-operative management rate can be achieved with selective embolization
J Trauma
Embolic therapy of hypersplenism
Invest Radiol
Evaluation of splenic embolization in patients with portal hypertension and hypersplenism
Ann Surg
Transcatheter occlusion of abdominal tumors
Radiology
Nonsurgical splenectomy
AJR Am J Roentgenol
Splenic infarction and spontaneous rupture of the spleen after therapeutic embolization
Cardiovasc Radiol
Ischemic therapy in thrombocytopenia from hypersplenism
Arch Surg
Partial splenic embolization in the treatment of hypersplenism
AJR Am J Roentgenol
Splenic embolization: a surgeon’s view
Cardiovasc Intervent Radiol
Spleen embolization
Ann Radiol (Paris)
Complications in splenic embolization
Ann Radiol (Paris)
Transcatheter arterial embolization—major complications and their prevention
Cardiovasc Intervent Radiol
Therapeutic arterial embolisation in children
Eur J Radiol
Partial splenic embolization in children with hypersplenism
Radiology
Partial splenic embolization: a treatment for hypersplenism
Ir Med J
Partial splenic embolization for painful splenomegaly
Cardiovasc Intervent Radiol
Partial splenic embolization in hypersplenism
Acta Paediatr Scand
Embolization to reverse severe recurrent hepatic encephalopathy
Arq Gastroenterol
Ischaemia and partial resection for control of splenic hyperfuncion
Br J Surg
Partial splenic embolization: an alternative to splenectomy in the treatment of hypersplenism
J Tenn Med Assoc
Transcatheteric partial splenic embolization (PSE) for azathioprine intolerance in renal transplant recipients
Transplant Proc
Splenic embolization for hypersplenism using steel coils
AJR Am J Roentgenol
Partial splenic embolization: experience in 136 patients
World J Surg
Hazards of splenic embolization
Clin Pediatr (Phila)
Creation of an intrahepatic portosystemic shunt with a Gruntzig balloon catheter
CMAJ
Portal hypertension, from Eck’s fistula to TIPS
Ann Surg
Esophageal bleeding disorders
Curr Opin Gastroenterol
Visceral angiography and embolization
Curr Opin Radiol
Advances in managing variceal bleeding in portal hypertension
Surg Annu
Long-term results of initial and repeated partial splenic embolization for the treatment of chronic idiopathic thrombocytopenic purpura
AJR Am J Roentgenol
Partial splenic embolization for the treatment of chronic idiopathic thrombocytopenic purpura
AJR Am J Roentgenol
Effectiveness of partial splenic embolization as treatment for hypersplensim in thalassemia major: a 7-year follow up
Eur J Haematol
Assessment of splenic and RES function of patients with thalassemia major long after partial splenic embolization: In vivo clearance study
Eur J Haematol
Cited by (110)
Variceal and Nonvariceal Upper Gastrointestinal Bleeding Refractory to Endoscopic Management: Indications and Role of Interventional Radiology
2024, Gastrointestinal Endoscopy Clinics of North AmericaLong-Term Effects of Proximal Splenic Artery Embolization on Splenic Volume and Platelet Count
2023, Annals of Vascular SurgeryA creatinine-based model for predicting recurrent bleeding after modified percutaneous transhepatic variceal embolization in patients with cirrhosis
2022, Journal of Interventional MedicineHemodynamic effect through a novel endoscopic intervention in management of varices and hypersplenism (with video)
2022, Gastrointestinal Endoscopy
None of the authors have identified a conflict of interest.