scholarly journals Guidewires as Embolic Agents? Embolotherapy of Large Splenic Artery Aneurysms

2021 ◽  
Author(s):  
Arafat Muhammed Haris ◽  
Jagdeesh Rampal Singh ◽  
Chitterusu Raghuram ◽  
Rebala Pradeep ◽  
D. Nageshwar Reddy
Keyword(s):  
Portal Hypertension ◽  
Blood Loss ◽  
Female Patient ◽  
Coil Embolization ◽  
Splenic Artery ◽  
Venous Pressure ◽  
Flow Characteristics ◽  
Portal Fibrosis ◽  
Embolic Agents ◽  
Aneurysmal Neck

AbstractSplenic artery aneurysms are among the more frequently diagnosed intra-abdominal aneurysms and are not infrequent in patients with raised portal venous pressure often requiring endovascular or surgical therapy. A 36-year-old female patient with Non-cirrhotic portal fibrosis and portal hypertension was diagnosed with multiple large splenic artery aneurysms for which she was initially operated which resulted in substantial blood loss during dissection that required embolotherapy. Initial attempts at coil embolization proved unsuccessful due to the wide aneurysmal neck and flow characteristics. Following which the aneurysmal sac was packed with multiple guidewires to act as a scaffold for further coil embolization. Subsequently, hemostasis was achieved and the patient underwent splenectomy later thereby demonstrating that embolization of large aneurysms can be accomplished with reasonable efficacy using guidewires.

scholarly journals Role of Splenic Artery Embolization in Gastric Variceal Hemorrhage due to Sinistral Portal Hypertension

2018 ◽  
Vol 03 (01) ◽  
pp. 027-036
Author(s):  
Bibin Sebastian ◽  
Soumil Singhal ◽  
Rohit Madhurkar ◽  
Arun Alex ◽  
M. Uthappa
Keyword(s):  
Portal Hypertension ◽  
Splenic Artery ◽  
Venous Pressure ◽  
Splenic Vein ◽  
Venous Hypertension ◽  
Variceal Hemorrhage ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Sinistral Portal Hypertension ◽  
Gastric Variceal Hemorrhage

AbstractSinistral or left-sided portal hypertension is a localized form of portal hypertension usually due to isolated obstruction of splenic vein. Most commonly, it is secondary to pancreatitis. Rarely this can present as life-threatening gastric variceal bleeding. In such patients, splenectomy is traditionally considered as the treatment of choice to relieve venous hypertension. Unfortunately, a surgical operation may not be safe in most of the patients because of the unfavorable operative field. Splenic artery embolization (SAE) is an effective method, theoretically akin to splenectomy, blocking the direct arterial inflow to the spleen and thereby reducing the outflow venous pressure. The authors demonstrate a case of a 58-year-old man who presented with severe gastric variceal hemorrhage due to sinistral portal hypertension (SPH) secondary to an episode of pancreatitis, which he had 1 month back. He was successfully managed by SAE and remains symptom-free. The authors bring to the fore the potential curability of gastric variceal hemorrhage secondary to SPH using SAE, which is a safe and effective interventional radiologic procedure.

NON-CIRRHOTIC PORTAL FIBROSIS CAUSING PORTAL HYPERTENSION

2021 ◽  
pp. 9-11
Author(s):  
Praveen. J ◽  
Tumbanatham. A
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Venous Pressure ◽  
Idiopathic Portal Hypertension ◽  
Unknown Etiology ◽  
Portal Fibrosis ◽  
Massive Splenomegaly ◽  
Extrahepatic Portal Venous Obstruction ◽  
Common Causes ◽  
Males And Females

Portal hypertension is more prevalent in patients with liver cirrhosis and occurs infrequently in those without liver cirrhosis. Non-cirrhotic portal brosis (NCPF) and extrahepatic portal venous obstruction (EHPVO) are the two most common causes of non-cirrhotic portal hypertension. Unlike EHPVO, NCPF does not cause thrombosis of the extrahepatic portal vein. Sclerosis of the portal vein's medium and small branches occurs in NCPF. In NCPF, the hepatic venous pressure gradient (HVPG) is normal, in contrast to cirrhosis, where it is increased. Additionally, NCPF is referred to as non-cirrhotic intrahepatic portal hypertension (NCIPH), idiopathic portal hypertension, hepatoportal sclerosis, and benign intrahepatic portal hypertension. It is a disease with an unknown etiology that primarily affects middle-aged males and females and manifests as hematemesis and massive splenomegaly

scholarly journals Preoperative splenic artery embolism followed by splenectomy is safe and effective in patients with sinistral portal hypertension

2021 ◽  
Author(s):  
Zihe Wang ◽  
Mao Li ◽  
Xing Huang ◽  
Junjie Xiong ◽  
Bole Tian
Keyword(s):  
Portal Hypertension ◽  
Blood Loss ◽  
Splenic Artery ◽  
Protective Factor ◽  
Pancreatic Pseudocyst ◽  
Operation Time ◽  
Postoperative Pancreatic Fistula ◽  
Intraoperative Blood Loss ◽  
Artery Embolism ◽  
Sinistral Portal Hypertension

Abstract Background Although preoperative splenic artery embolism (SAE) has been widely used for splenomegaly, the efficiency and safety of preoperative SAE in patients with sinistral portal hypertension (SPH) is unknown. Methods We designed a retrospective cohort of SPH patients who received preoperative SAE in our hospital (February 2018 to September 2020) and compared to those who received splenectomy only, in terms of intraoperative and postoperative outcomes. Results In all, 59 patients (18 patients received preoperative SAE) were analyzed. The median age was 44.7 years. Preoperative SAE reduced the intraoperative blood loss (637.0 vs. 420.3 ml, P = 0.041) and operation time (174.0 vs. 141.5 min, P = 0.012). The incidence of complications including postoperative pancreatic fistula (POPF), bleeding, and thromboembolism was comparable. Multivariate analysis showed that SAE was a protective factor for intraoperative blood loss and operation time, while prior pancreatic pseudocyst/abscess was a risk factor. Conclusions Preoperative SAE could reduce intraoperative blood loss and operation time in SPH patients without increasing the incidence of complications compared to splenectomy only.

scholarly journals Transcatheter Embolization for Giant Splenic Artery Aneurisms: Still an Open Question

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Marianna Mastroroberto ◽  
Sonia Berardi ◽  
Matteo Renzulli ◽  
Caterina Maggioli ◽  
Paolo Pianta ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Bacterial Infection ◽  
Liver Transplant ◽  
Hepatic Failure ◽  
Coil Embolization ◽  
Splenic Artery ◽  
Transcatheter Embolization ◽  
Endovascular Techniques ◽  
Transcatheter Coil Embolization ◽  
Open Question

Transcatheter embolization is the mainstay of the therapy of splenic artery aneurysms (SAAs) in patients with portal hypertension. It is indicated when the SAA diameter reaches 20 mm. Although endovascular techniques are effective and safe for the treatment of medium-sized SAAs, little is known about their applicability to large-sized SAAs. Herein, we report a case of giant SAA, which was treated with transcatheter coil embolization. The case was not considered suitable for surgery because of the presence of severe portal hypertension. The procedure was complicated by bacterial infection of the coils within the aneurismatic sac, leading to the development of hepatic failure. A liver transplant was then successfully performed despite the presence of a nonresponsive infection.

Coil-Embolization of the Splenic Artery after a Penetrating Gunshot Injury

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 87-91 ◽  
Author(s):  
Schertler ◽  
Pfammatter ◽  
Eid ◽  
Wildermuth
Keyword(s):  
Operative Therapie ◽  
Coil Embolization ◽  
Splenic Artery ◽  
Gunshot Injury ◽  
Therapeutische Maßnahmen

Die moderne Computer-Tomographie (CT) ist heutzutage für das Management schwerverletzter Patienten im Notfall nicht mehr wegdenkbar. Zudem ist die abdominelle CT eine zuverlässige Methode zur Identifizierung von Milzverletzungen und kann weitere intraabdominelle oder thorakale Verletzungen ausschliessen. Stumpfe und penetrierende Milzverletzungen benötigen unverzüglich therapeutische Massnahmen. Prinzipiell gelten als Voraussetzungen für eine nicht-operative Therapie die hämodynamische Stabilität des Patienten, das Fehlen zusätzlicher Verletzungen der abdominellen Hohlorgane und des Schädels sowie das Fehlen vorangegangener Baucheingriffe. Die konventionelle Angiographie kann einerseits zur Diagnosestellung und anderseits zur Embolisierung traumatisch bedingter Verletzungen der Milzgefässe sämtlicher Schweregrade, welche mittels CT diagnostiziert und nicht-operativ therapiert wurden, verwendet werden. Der vorliegende Fall demonstriert einen Patienten mit Schussverletzung des linken Hemiabdomens. Aufgrund der hämodynamischen Stabilität des Patienten sowie der persönlichen Anamnese mit bereits stattgehabtem abdominellen Eingriff und aufgrund fehlender weiterer Verletzungen des Abdomens und des Schädels wurde ein nicht-operativer Therapieansatz gewählt mit Embolisierung der proximalen Milzarterie.

scholarly journals Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review

2021 ◽  
Vol 5 (02) ◽  
pp. 079-085
Author(s):  
Harriet Grout-Smith ◽  
Ozbil Dumenci ◽  
N. Paul Tait ◽  
Ali Alsafi
Keyword(s):  
Systematic Review ◽  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Splenic Artery ◽  
Splenic Vein ◽  
Treatment Modalities ◽  
Portal System ◽  
Technical Success Rate ◽  
Randomized Controlled Studies ◽  
Sinistral Portal Hypertension

Abstract Objectives Sinistral portal hypertension (SPH) is caused by increased pressure on the left portal system secondary to splenic vein stenosis or occlusion and may lead to gastric varices. The definitive management of SPH is splenectomy, but this is associated with significant mortality and morbidity in the acute setting. In this systematic review, we investigated the efficacy and safety of splenic artery embolisation (SAE) in managing refractory variceal bleeding in patients with SPH. Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies. Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities. Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.

scholarly journals P225 Partial splenic artery embolisation for portal hypertension – a single centre experience

2021 ◽  
Author(s):  
Jie Han Yeo ◽  
Brian Hogan ◽  
Nigel Heaton ◽  
Vishal Patel ◽  
Mark McPhail ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Splenic Artery ◽  
Single Centre ◽  
Single Centre Experience

Decreased vascular contractile and inositol phosphate responses in portal hypertensive rats

1995 ◽  
Vol 73 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Yi-Tsau Huang ◽  
Chuang-Ye Hong ◽  
Pi-Chin Yu ◽  
Ming-Fang Lee ◽  
May C. M. Yang ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Contractile Response ◽  
Inositol Phosphates ◽  
Inositol Phosphate ◽  
Venous Pressure ◽  
Portal Vein Ligation ◽  
Sprague Dawley ◽  
Hypertensive Rats ◽  
Contractile Responses ◽  
Tail Artery

The purpose of this study was to investigate the vascular contractile and inositol phosphate responses in portal hypertensive rats. Portal hypertension was induced by partial portal vein ligation (PVL) in Sprague–Dawley rats. Sham-operated rats served as controls. Pressures, vasoconstrictor responses, and inositol phosphate responses were determined at 14 days after surgery. The portal venous pressure was significantly higher, while systemic arterial pressure and heart rate were lower, in PVL rats. Dose-dependent contractile responses were observed for both norepinephrine (1 × 10−8 – 3 × 10−6 M) and vasopressin (3 × 10−10 – 3 × 10−8 M) in the tail artery of both groups. The contractile response to norepinephrine was significantly decreased in PVL rats compared with controls at all doses. The contractile response to vasopressin was significantly decreased in PVL rats at higher doses. After myo-[3H]inositol incorporation in tail artery, the levels of 3H-labelled phosphatidylinositols (cpm/mg) were similar between the two groups. Norepinephrine (10−7 – 10−5 M) and vasopressin (10−10 – 10−8 M) dose dependently stimulated the 3H-labelled inositol phosphate production in the tail artery of both PVL and sham-operated rats. However, the response was significantly lower in PVL rats. The results suggested that the attenuation of vascular contractile responses in portal hypertension was reflected in the phosphoinositide messenger system.Key words: portal hypertension, inositol phosphates, phosphoinositide, tail artery, contractile response.

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