Partial splenic embolization in patients with cirrhosis: efficacy, tolerance and long-term outcome in 32 patients

• Published in: European journal of gastroenterology & hepatology Vol. 17; no. 2; pp. 179 - 184
• Main Authors: NʼKontchou, Gisèle, Seror, Olivier, Bourcier, Valérie, Mohand, Djamila, Ajavon, Yves, Castera, Laurent, Grando-Lemaire, Véronique, Ganne-Carrie, Nathalie, Sellier, Nicolas, Trinchet, Jean-Claude, Beaugrand, Michel
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-02-2005; Lippincott Williams & Wilkins
• Subjects: Abscess - etiology; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Human bacterial diseases; Humans; Hypersplenism - etiology; Hypersplenism - therapy; Infectious diseases; Leukopenia - etiology; Leukopenia - therapy; Liver Cirrhosis - complications; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Retrospective Studies; Splenic Diseases - etiology; Splenomegaly - etiology; Splenomegaly - therapy; Thrombocytopenia - etiology; Thrombocytopenia - therapy; Treatment Outcome; Human; Prognosis; complications; Splenic disease; Tolerance; Instrumentation therapy; Hepatic disease; Hemopathy; Long term; partial splenic embolization; Cirrhosis; Partial; Efficiency; Hypersplenism; Digestive diseases; Complication; Embolization; Liver abscess
• ISSN: 0954-691X; 1473-5687
• DOI: 10.1097/00042737-200502000-00008

BACKGROUNDAlthough partial splenic embolization (PSE) has been proposed in patients with cirrhosis in cases when thrombocytopenia or neutropenia may cause clinical manifestations or if there are contra-indications to other therapeutic procedures, there are limited data on long-term outcome. We provide a retrospective review of results and the tolerance of all PSE procedures in patients with cirrhosis in our department.
PATIENTS AND METHODSThirty-two consecutive patients with cirrhosis were included over a 6 year period. Indications for PSE were as follows(1) severe cytopenia preventing necessary antiviral treatment (n=14), percutaneous destruction of hepatocellular carcinoma (n=8) or major surgery (n=3), severe purpura (n=3); (2) painful splenomegaly (n=4). After superselective catheterization, embolization was performed with up to 50% reduction of splenic blood flow.
RESULTSThrombocyte and leucocyte counts increased markedly (185% and 51% at 1 month; 95% and 30% at 6 months). Thirty-one and 20 patients had platelet count >80 000/mm at months 1 and 6 vs only one before PSE. Overall, the aim of PSE was achieved in 27 patients (84%) (planned treatment20/25; disappearance of purpura and splenic pain7/7). Severe complications occurred in five patients (16%)transient ascites (n=2), splenic and/or portal vein thrombosis (n=2) that resolved after anticoagulation therapy, and splenic abscess (n=2) leading to death. These two patients had splenic necrosis >70%.
CONCLUSIONIn patients with cirrhosis, PSE may resolve cytopenia and the clinical complications related to hypersplenism or splenomegaly. However, due to a high risk of severe complications, particularly splenic abscess, the indications of PSE should be very limited and the extent of necrosis should be strictly controlled during the PSE procedure.