Portal de Periódicos da CAPES

Partial splenic artery embolization for treatment of Hypersplenism in portal hypertension: Experience from tertiary referral centre

2023; Elsevier BV; Volume: 13; Linguagem: Inglês

10.1016/j.jceh.2023.07.284

2213-3453

Mayur Satai, Arun Vaidya, Abu Asim Akhtar Ansari, Akash Shukla,

Abdominal vascular conditions and treatments

Background and Aim: Hypersplenism is a complication of portal hypertension commonly encountered in gastroenterology practice. Partial splenic artery embolization (PSAE) is one of the attractive treatment modalities, which is less invasive than splenectomy for managing hypersplenism. We aimed to evaluate the safety and efficacy of PSAE in treating hypersplenism in portal hypertension. Methods: We analyzed the prospectively collected data of patients who underwent PSAE for hypersplenism from January 2022 to December 2022 and followed them periodically. Demography, etiology of portal hypertension, baseline hemogram and presence of splenic artery aneurysm was noted. Primary outcome measures were improvement in hematological parameters (red blood cell counts, white blood cell counts, platelet counts) and improvement in clinical parameters (need of transfusion). Secondary outcome measures included the complications related to the procedures. Results: Total 11 patients were reviewed. Females were 7 (63.6%). Mean age was 34.6 years. Extrahepatic portal vein obstruction and non-cirrhotic portal fibrosis as etiology of portal hypertension were present in 5 (45.5%) and 3 (27.3%) cases respectively. Three patients were cirrhotic (HBV: 2 cases, NASH: 1 case) and all were CTP-A. Concomitant splenic artery aneurysm was present in 5 (45.5%) cases. Technical success was achieved in 100% of cases. Mean spleen size was 20.5 cm, which reduced by 1-2 cm post procedure in majority cases. Post embolization, RBCs, WBCs and platelet counts were significantly improved at 4 weeks, 12 weeks and 24 weeks follow up (p-value <0.05) with no requirement of blood product transfusion in any patient. Post embolization syndrome (fever, pain and nausea/vomiting) manifested in all cases and managed conservatively. One patient developed transient ascites with spontaneous bacterial peritonitis, which subsequently resolved. One patient developed splenic abscess and sepsis and ultimately died post splenectomy. Conclusion: PSAE is a safe and effective treatment for hypersplenism with good short-term outcomes.