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Long-Term Effects of Proximal Splenic Artery Embolization on Splenic Volume and Platelet Count. Ann Vasc Surg 2023; 89:166-173. [PMID: 36328348 DOI: 10.1016/j.avsg.2022.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The spleen is the most commonly injured visceral organ in blunt abdominal trauma. Post-splenectomy infection risk has led to the shift toward spleen preserving procedures and splenic artery embolization (SAE) is now the treatment of choice for hemodynamically stable patients with splenic injury. This study aims to assess the long-term effect of SAE on splenic volume and platelet count. MATERIALS AND METHODS Using CPT codes, 66 patients who underwent SAE were identified, and 14 of those who had the necessary imaging and laboratory follow-up were included in the study. Indications for SAE were portal hypertension in 8 patients, bleeding in 4 patients, and thrombocytopenia in 1, and one patient had a separate indication. Splenic volume was calculated by automated volumetric software (Aquarius, TeraRecon, Inc.). Paired t-tests were performed to compare splenic volume and platelets before and after SAE. RESULTS Fourteen patients (7 males, 7 females) with a mean age of 51 ± 11.95 years underwent SAE and were followed by a repeat computed tomography scan at an average of 733.57 days. Nine SAEs were performed using vascular plugs, 3 using micro coils, and 2 out of that were with Gelfoam slurry, and 2 using coils only. All embolizations were technically successful with complete cessation of flow. Mean splenic volumes pre- and post-SAE were 903.5 ± 523.73 cm3 and 746.5 ± 511.95 cm3, respectively, representing a mean decrease of 8.31% compared to baseline [P = 0.346]. Minimum platelet counts (x103) pre-SAE (within 3 months) and post-SAE (2 weeks to 3 months after the procedure) were 55.79 ± 57.11 and 116 ± 145.40, respectively. The minimum platelet count showed a statistically significant mean increase of 134.92% (P = 0.033). CONCLUSIONS The splenic volume is not altered significantly by SAE in the long term. Similarly, the platelet count is also not significantly altered at 3 months follow-up. This study, although small, suggests that SAE is a safe intervention that can preserve splenic volume and function in the long term.
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Interventional Management of Portal Hypertension in Cancer Patients. Curr Oncol Rep 2022; 24:1461-1475. [PMID: 35953600 DOI: 10.1007/s11912-022-01319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the classifications and clinical hallmarks of common cancer-related conditions that contribute to the high incidence of portal hypertension in this population and provide an update on currently available interventional radiology therapeutic approaches. RECENT FINDINGS In the last few decades, there have been significant advancements in understanding the pathophysiology of portal hypertension. This knowledge has led to the development of safer and more effective minimally invasive approaches. The main objective is to provide alternatives to prevent life-threatening complications from clinically significant portal hypertension and to allow the continuation of cancer treatment interventions that would otherwise be stopped. Clinicians involved in cancer care should be aware of risk factors, associated complications, and management of portal hypertension in cancer patients. Interventional radiology offers minimally invasive alternatives that play a central role in improving clinical outcomes and survival of these patients, allowing the continuation of cancer treatments.
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Evaluation of the effectiveness of partial splenic endovascular embolization in patients with refractory thrombocytopaenia. Pol J Radiol 2022; 87:e369-e374. [PMID: 35979150 PMCID: PMC9373866 DOI: 10.5114/pjr.2022.118159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/11/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Partial splenic endovascular embolization (PSEE) could be an option for patients with thrombocytopaenia (TCP). We selected a group of 22 patients diagnosed with refractory TCP to undergo PSEE, and we followed them for detailed analysis. Material and methods Twenty-two patients aged 27-75 years (mean 46.5 ± 3.5 years) underwent PSEE, and 5 participants underwent a second PSEE due to the lack of effectiveness after the first procedure. A total of 27 PSEEs were performed. A semi-quantitative scale was used to assess the severity of the post-embolization syndrome. The percentage of spleen parenchyma excluded from circulation was 30-70%. We used the mixture of Histoacryl N-butyl cyanoacry-late glue and Lipiodol in 10 cases, spirals in 10 cases, and polyvinyl alcohol in 7 cases, for the embolization. Results The mean value of platelet count (PLT) before procedure increased from 22.0 ± 15.0 to 87.7 ± 67.9 (p < 0.05) in a mean period of 194 days. In 2 cases severe post-embolization syndrome was observed. Closure less than 50% of the spleen circulation was associated with poorly expressed post-embolization symptoms. Serious complications occurred in 1 patient (3.5%). A strong positive correlation (r = 0.8, p < 0.05) was found between C-reactive protein (CRP) and the severity of post-embolization syndrome. Increased symptoms of post-embolization syndrome were also associated with a significant increase in hospitalization time – 27.0 vs. 7.2 days (r = 0.66, p < 0.05). Conclusions Partial endovascular embolization of the spleen (PSEE) may be a valuable therapeutic option for patients with refractory TCP. PSEE is a safe method with a low complication rate.
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Jalili J, Pourghorban R, Mahmoudpour M, Akhavi Milani A. Partial Splenic Embolization for the Management of Severe Refractory Thrombocytopenia in Antiphospholipid Syndrome: A Case Report and Literature Review. Vasc Endovascular Surg 2022; 56:316-320. [PMID: 34978216 DOI: 10.1177/15385744211072682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antiphospholipid syndrome is an autoimmune condition characterized by arteriovenous thromboembolic events. Thrombocytopenia is a common finding among these patients and is typically of mild severity not requiring any treatment. However, severe cases of thrombocytopenia should be treated. Steroids, intravenous immune globulin (IVIG), and immunomodulatory agents are the first-line treatment options, and surgical splenectomy is usually reserved for more severe and refractory cases of thrombocytopenia. Herein, we report the case of a 30-year-old man with primary antiphospholipid syndrome and severe thrombocytopenia. The patient's thrombocytopenia had been refractory to almost all the medical managements, and surgical splenectomy could not be an option due to the patient's high-risk condition for surgery. The patient was successfully managed by partial splenic embolization (PSE) which was a unique application of this technique.
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Affiliation(s)
- Javad Jalili
- Department of Interventional Radiology, Emam Reza Hospital, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramin Pourghorban
- Department of Medical Imaging, 6488Nepean Hospital, Kingswood, NSW, Australia
| | - Masoud Mahmoudpour
- Department of Interventional Radiology, Emam Reza Hospital, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Akhavi Milani
- Department of Interventional Radiology, Emam Reza Hospital, 48432Tabriz University of Medical Sciences, Tabriz, Iran
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Dariushnia SR, Redstone EA, Heran MKS, Cramer HR, Ganguli S, Gomes AS, Hogan MJ, Himes EA, Patel S, Schiro BJ, Lewis CA. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Transcatheter Embolization. J Vasc Interv Radiol 2021; 32:476.e1-476.e33. [PMID: 33640083 DOI: 10.1016/j.jvir.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303.
| | - Ellen A Redstone
- Department of Interventional Radiology, St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA, 18015
| | - Manraj K S Heran
- Pediatric Interventional Radiology, Diagnostic & Therapeutic Neuroradiology, British Columbia's Children's Hospital, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, Canada
| | - Harry R Cramer
- Section of Interventional Radiology, Coastal Vascular and Interventional, PLLC, 3155 Hyde Park Place, Pensacola, FL, 32503
| | - Suvranu Ganguli
- Department of Radiology, Division of Interventional Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH 4th Floor, Boston, MA, 02118
| | - Antoinette S Gomes
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plz Ste 2125, Los Angeles, CA, 90095-8358
| | - Mark J Hogan
- Department of Radiology, Section of Vascular and Interventional Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Elizabeth A Himes
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Sheena Patel
- Society of Interventional Radiology, 3975 Fair Ridge Drive, Suite 400 North, Fairfax, VA, 22033
| | - Brian J Schiro
- Department of Vascular & Interventional Radiology, Miami Cardiac & Vascular Institute, 8900 N. Kendall Drive, Miami, FL, 33156, United States
| | - Curtis A Lewis
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Dr, SE, Atlanta, GA, 30303
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Kis B, Mills M, Smith J, Choi J, Sagatys E, Komrokji R, Strosberg J, Kim RD. Partial Splenic Artery Embolization in 35 Cancer Patients: Results of a Single Institution Retrospective Study. J Vasc Interv Radiol 2019; 31:584-591. [PMID: 31471193 DOI: 10.1016/j.jvir.2019.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of partial splenic embolization (PSE) in cancer patients with different etiologies of splenomegaly/hypersplenism. MATERIALS AND METHODS The medical records of 35 cancer patients who underwent 39 PSE procedures were analyzed. The splenomegaly/hypersplenism was due to chemotherapy (n = 17), portal hypertension (n = 10), or hematologic malignancy (n = 8). After the first 11 PSEs, celiac plexus neurolysis, corticosteroids, and non-steroid anti-inflammatory drugs (NSAIDs) were included in the post-procedural management. RESULTS PSE led to 59 ± 16% (mean ± standard deviation) splenic infarcts. The infarct volume per 1 mL 300-500 μm tris-acryl gelatin microspheres was not significantly different between the chemotherapy-induced group (264 ± 89 cm3) and the portal hypertension group (285 ± 139 cm3) but was significantly higher in the hematology group (582 ± 345 cm3). Platelet count increased from 65.7 ± 19.7 k/μl to a peak platelet count of 221 ± 83 k/μl at 2 weeks after PSE. Patients with a follow-up period of more than 1 year had the most recent platelet count of 174 ± 113 k/μl. Platelet count increase was significantly higher in the chemotherapy-induced group than the portal hypertension group. Adding celiac plexus neurolysis, corticosteroids, and NSAIDs to the post-procedural management resulted in a decreased rate of major complications from 73% to 46% and a decrease in the rate of moderate or severe pain from 92% to 20%. CONCLUSIONS PSE improved platelet counts in cancer patients despite different etiologies of splenomegaly. The addition of celiac plexus neurolysis, corticosteroids, and NSAIDS to the post-PSE treatment protocol reduced complications. Data from this study could help to predict the amount of 300-500 μm tris-acryl gelatin microspheres required to achieve a planned infarct size.
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Affiliation(s)
- Bela Kis
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612.
| | - Matthew Mills
- Department of Radiation Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612
| | - Johnna Smith
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612
| | - Junsung Choi
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612
| | - Elizabeth Sagatys
- Department of Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612
| | - Rami Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612
| | - Jonathan Strosberg
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612
| | - Richard D Kim
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612
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Partial splenic embolization in the treatment of prolonged thrombocytopenia due to hypersplenism in metastatic cancer patients. Support Care Cancer 2018; 26:3527-3532. [DOI: 10.1007/s00520-018-4192-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/03/2018] [Indexed: 12/21/2022]
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Luz JHM, Luz PM, Marchiori E, Rodrigues LA, Gouveia HR, Martin HS, Faria IM, Souza RR, Gil RDA, Palladino ADM, Pimenta KB, de Souza HS. Partial splenic embolization to permit continuation of systemic chemotherapy. Cancer Med 2016; 5:2715-2720. [PMID: 27611010 PMCID: PMC5083724 DOI: 10.1002/cam4.856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/08/2016] [Accepted: 07/16/2016] [Indexed: 12/16/2022] Open
Abstract
Systemic chemotherapy treatments, commonly those that comprise oxaliplatin, have been linked to the appearance of distinctive liver lesions that evolves to portal hypertension, spleen enlargement, platelets sequestration, and thrombocytopenia. This outcome can interrupt treatment or force dosage reduction, decreasing efficiency of cancer therapy. We conducted a prospective phase II study for the evaluation of partial splenic embolization in patients with thrombocytopenia that impeded systemic chemotherapy continuation. From August 2014 through July 2015, 33 patients underwent partial splenic embolization to increase platelets count and allow their return to treatment. Primary endpoint was the accomplishment of a thrombocyte level superior to 130 × 109/L and the secondary endpoints were the return to chemotherapy and toxicity. Partial splenic embolization was done 36 times in 33 patients. All patients presented gastrointestinal cancer and colorectal malignancy was the commonest primary site. An average of 6.4 cycles of chemotherapy was done before splenic embolization and the most common regimen was Folfox. Mean platelet count prior to embolization was 69 × 109/L. A total of 94% of patients achieved primary endpoint. All patients in need reinitiated treatment and median time to chemotherapy return was 14 days. No grade 3 or above adverse events were identified. Aiming for a 50% to 70% infarction area may be sufficient to achieve success without the complications associated with more extensive infarction. Combined with the better safety profile, partial splenic embolization is an excellent option in the management of thrombocytopenia, enabling the resumption of systemic chemotherapy with minimal procedure‐related morbidity.
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Affiliation(s)
- Jose Hugo M Luz
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
| | - Paula M Luz
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo A Rodrigues
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Hugo R Gouveia
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Henrique S Martin
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Igor M Faria
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Roberto R Souza
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Roberto de Almeida Gil
- Department of Clinical Oncology, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | | | - Karina B Pimenta
- Department of Anesthesiology, National Cancer Institute, INCA, Rio de Janeiro, Brazil
| | - Henrique S de Souza
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
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