Temporary splenic artery balloon occlusion for protection of nonsplenic vascular beds during splenic embolization

The use of splenic embolization in immune thrombocytopenia: A systematic review and meta-analysis

The effectiveness of splenic embolization (SE) in treating refractory immune thrombocytopenia (ITP) remains uncertain. A systematic literature review was undertaken to assess the effectiveness and safety of SE in treating both paediatric and adult patients with ITP. We conducted an extensive search employing predefined criteria. We extracted platelet counts at baseline and at multiple intervals following SE, along with details of the proportion of embolized spleen parenchyma and the proportion of patients exhibiting complete or partial platelet count responses. We identified nine eligible reports for the analysis of effectiveness (228 patients) and 15 reports for the safety analysis (151 patients). Pooled estimates of complete response (platelet count >100 × 109/L) and overall response (platelet count >30 × 109/L) were 50.1% (95% CI: 38-62.3) and 74.4% (95% CI: 64.9-83.9) respectively. Most studies applied an embolization of at least 60% of the spleen parenchyma. Nearly all the patients suffered from mild adverse events (AEs), 1.3% suffered from serious AEs and one patient died (0.7%). In conclusion, SE resulted in an overall response rate in 74.4% of patients with ITP. However, this finding derives from uncontrolled studies of low to moderate quality.

Embolotherapy for Hepatic Oncology: Current Perspectives and Future Directions

Primary and secondary liver cancers are a major cause of mortality worldwide. Transarterial liver-directed therapy, or embolotherapy, represents an important locoregional treatment strategy for primary and secondary liver tumors. Embolotherapeutic modalities include bland embolization (transarterial embolization), chemoembolization (transarterial chemoembolization), and radioembolization or selective internal radiotherapy. A brief technical overview of embolotherapeutic modalities as well as supportive evidence for the treatment of most common primary and secondary liver tumors will be discussed in this review. Several potential future applications, including synergy with systemic therapy, interventional theranostics, and artificial intelligence will also be reviewed briefly.

Novel use of the Surefire antireflux device in subtotal splenic embolization

An unstable patient presented with an enlarging splenic hematoma, for whom splenectomy was contraindicated. The decision was made to treat this patient with subtotal splenic embolization. Initial attempts at embolotherapy using a conventional end-hole catheter resulted in a false angiographic end point with reflux into short gastric arteries, likely due to splenic parenchymal pressurization from the hematoma. The Surefire antireflux device (Surefire Medical Inc, Westminster, Colo) was therefore employed. The Surefire device allowed successful subtotal splenic embolization. Whereas it is currently primarily used in hepatic interventional oncology, we have shown that it can be successfully used in other settings to increase embolization efficiency while mitigating nontargeted embolization.