Abstract
Background Splenic artery embolization is becoming a widely acceptable procedure for nonsurgical management in many clinical settings such as pseudoaneurysms or to salvage splenic functions in portal hypertension, hypersplenism, and secondary prophylaxis in variceal hemorrhage. Various published meta-analyses of splenic artery embolization found an overall success rate of 90% in vascular abnormality.
Methods Retrospective study of all splenic artery embolization procedures in 1 year (January 2017–2018) to analyze various indications, procedure technique, and its modification as well as outcome measurement and complications.
Results Total 16 splenic artery embolization procedures were performed including one case of percutaneous trans-splenic glue embolization in 1-year duration.
Procedure Indication It included pseudoaneurysm (n = 7, 44%); trauma (n = 1, 6%); adjuvant to surgical splenectomy in hypersplenism (n = 3, 18%); secondary prophylaxis in portal hypertension, portosystemic varices with/without reduced platelet counts, or ascites (n = 4, 25%); and Budd-Chiari syndrome (n = 1, 6%). Total 13 (81%) procedures were elective, whereas emergency embolization was performed in 3 (18.7%). Endovascular technical success was 93.7% (n = 15) cases. Percutaneous trans-splenic embolization was performed in one (6%) case in which access to bleeding point was not possible. The embolic agents included combination of metallic coils (n = 14, 87.5%), Gelfoam (n = 6, 37.5%), polyvinyl alcohol (PVA) particles (n = 5, 31%), and cyanoacrylate glue (n = 3, 18.7%). Complication rate was low with development of splenic abscess with infected pyothorax in one (6%) case of hypersplenism requiring pigtail drainage with uneventful full recovery.
Conclusion Splenic artery embolization provides safer nonsurgical options in management of cases such as trauma, hypersplenism, portal hypertension for control of hemorrhage and preservation of splenic function. Endovascular embolization facilitates complete exclusion of pseudoaneurysms in majority with percutaneous splenic embolization using glue or coils as a safer alternative where endovascular access to bleeding vessels is difficult.
EUS-guided splenic artery embolization for variceal hemorrhage: balancing creativity and innovation in Endo-hepatology with caution
