Partial splenic embolization for hypersplenism after liver transplantation

Partial splenic embolization in the treatment of patients with portal hypertension: a review of the english language literature

This article reviews the existing literature on the use of partial splenic embolization in patients with portal hypertension. All articles published in the English language on splenic embolization or partial splenic embolization as a treatment for portal hypertension were identified with a PubMed search from 1973 through 2005. Partial splenic embolization appears to be efficacious in reducing episodes of variceal bleeding, improving hematologic parameters, enhancing hepatic protein synthesis, and reducing the severity of hepatic encephalopathy. Associated morbidity and mortality appear to be acceptable. The literature, however, is limited in quality. Given the potential benefits of partial splenic embolization, further investigation is warranted to allow evidence-based evaluation of its use.

Comparison of two different percutaneous splenic artery interventions in the treatment of hypersplenism: preliminary report

BACKGROUND

Splenomegaly and hypersplenism occur in patients with chronic liver disease and liver transplant recipients. The traditional treatment for hypersplenism is surgical removal. Percutaneous interventional methods, such as partial splenic embolization, are alternatives to surgery for hypersplenism. This article gives preliminary findings for a new percutaneous technique in which a narrowed stent is placed in the splenic artery.

METHODS

The study focused on 10 patients (eight males and two females) who were treated for hypersplenism. Partial splenic embolization was performed in six patients (age range, 1-43 years) who were waiting for liver transplantation, and narrowed stents were placed in four patients (age range, 12-47 years) who had undergone either orthotopic two patients) or heterotopic two patients) liver transplantation. For embolization, the splenic artery was catheterized and polyvinyl alcohol particles were infused to the distal branches, reducing blood flow in the spleen by 40% to 50%. In the other cases, a narrowed stent was deployed to the middle portion of the splenic artery.

RESULTS

Hypersplenism was successfully treated in all 10 cases. Compared with partial splenic embolization, placement of narrowed stents was associated with lower frequencies of postintervention fever and pain, shorter hospital stay, and decreased need for antibiotics. In addition to treating hypersplenism, narrowed-stent placement also completely resolved splenic artery steal syndrome in the two patients (orthotopic liver transplant recipients) with this condition.

CONCLUSION

Percutaneous placement of a narrowed stent in the splenic artery is a promising new technique for treating hypersplenism and splenic arterial steal syndrome.

Evaluation of a canine model of secondary hypersplenism induced by splenic vein ligation

AIM

To introduce and evaluate a canine model of secondary hypersplenism induced by splenic vein ligation.

METHODS

Eighteen healthy mongrel dogs were randomly divided into three groups. The first group (n = 4) underwent laparotomy, the second (n = 10) and third groups (n = 4) underwent laparotomy plus ligation of splenic vein and its collateral branches to induce congestive splenomegaly. At the end of the third week, splenectomy was performed in the third group. The blood cell counts for peripheral venous blood were determined weekly, and the radiographic and histopathological changes of spleen also obtained regularly.

RESULTS

The erythrocyte and platelet counts decreased in the first week, and were significantly lowered (erythrocyte count of (6.8 ± 1.2)×10¹²/L in control vs (5.1± 0.7)×10¹²/L in second group, P<0.01; and platelet counts of (398 ± 58)×10⁹/L vs (230 ± 86)109/L, P<0.05 respectively) at the end of 3rd week after splenic vein ligation thereafter sustained. The splenomegaly, erythrocytopenia and thrombocytopenia had remained over 9 weeks. No significant changes of the leukocyte counts were observed after splenic vein ligation throughout the experiment (P>0.05). The abnormal status of erythrocytopenia and thrombocytopenia was ameliolated by splenectomy, and the erythrocyte and platelet counts were similarly to the levels of the control group in the second week after splenectomy. After the end of 3rd week after splenic vein ligation, the splenic histopathological changes conformed to the changes of chronic congestive splenomagely.

CONCLUSION

The method of splenic vein ligation to induce experimental secondary hypersplenism is simple and effective. This is a relative ideal model for surgical or interventional therapy on hypersplenism.