Abstract
Background
Partial splenic embolization (PSE) was introduced in the 1980s. We studied the long-term follow-up results of a PSE-treated patient cohort.
Patients and methods
Twenty-six severely ill patients (median age 63.5 years) were treated with a graded PSE a total of 52 times, mainly due to bleeding esophageal varices and thrombocytopenia. The aggregated follow-up time was 1715 months.
Results
The mean values of hemoglobin, leukocytes and thrombocytes increased significantly after PSE. The frequency of bleeding episodes from esophageal varices was significantly reduced. No effect was observed concerning blood liver parameters in cirrhotic patients. The integrated PSE effect was judged as improvement in 19 patients, status quo in 5, and deterioration in 2. Median survival time was 50.5 months (range 0.5–272 months). Two patients underwent liver transplantation. Complications consisted mainly of fever, atelectasis, and abdominal pain. Two patients died of PSE-related complications.
Conclusions
A standardized and graded PSE is reasonably safe even in patients with advanced disease in whom it is hazardous to splenectomize. It gives a long-term effect on the hematological parameters, bleedings from esophageal varices and good palliation, and improved clinical status contributing to symptomatic control.
Similar content being viewed by others
References
Maddison FE (1973) Embolic therapy of hypersplenism. Invest Radiol 280–281
Trojanowski JQ, Harrist TJ, Athanasoulis CA, et al (1980) Hepatic and splenic infarctions. Complications of therapeutic transcatheter embolization. Am J Surg 139:272–277
Castaneda-Zuniga WR, Hammerschmidt DE, Sanchez R, Amplatz K (1977) Nonsurgical splenectomy. AJR Am J Roentgenol 129:805–811
Back LM, Bagwell CE, Greenbaum BH, Marchildon MB (1987) Hazards of splenic embolization. Clin Pediatr (Phila) 26:292–295
Vujic I, Lauver JW (1981) Severe complications from partial splenic embolization in patients with liver failure. Br J Radiol 54:492–495
Alwmark A, Bengmark S, Gullstrand P, Joelsson B, Lunderquist A, Owman T (1982) Evaluation of splenic embolization in patients with portal hypertension and hypersplenism. Ann Surg 196:518–524
Mozes MF, Spigos DG, Pollak R, Abejo R, Pavel DG, Tan WS, Jonasson O (1984) Partial splenic embolization, an alternative to splenectomy. Results of a prospective, randomized study. Surgery 96:694–701
Pinca A, DiPalma A, Soriani S, Sprocati M, Mannella P, Georgacopulo P, Bagni B, Vullo C (1992) Effectiveness of partial splenic embolization as treatment for hypersplenism in thalassaemia major: a 7-year follow up. Eur J Haematol 49:49–52
Zannini G, Masciariello S, Pagano G, Sangiuolo P, Zotti G, Iaccarino V (1983) Percutaneous splenic artery occlusion for portal hypertension. Arch Surg 118:897–900
Miyazaki M, Itoh H, Kaiho T, Ohtawa S, Ambiru S, Hayashi S, Nakajima N, Oh H, Asai T, Iseki T (1994) Partial splenic embolization for the treatment of chronic idiopathic thrombocytopenic purpura. AJR Am J Roentgenol 163:123–126
Sakata K, Hirai K, Tanikawa K (1996) A long-term investigation of transcatheter splenic arterial embolization for hypersplenism. Hepatogastroenterology 43:309–318
Murata K, Shiraki K, Takase K, Nakano T, Tameda Y (1996) Long term follow-up for patients with liver cirrhosis after partial splenic embolization. Hepatogastroenterology 43:1212–1217
Sangro B, Bilbao I, Herrero I, Corella C, Longo J, Beloqui O, Ruiz J, Zozaya JM, Quiroga J, Prieto J (1993) Partial splenic embolization for the treatment of hypersplenism in cirrhosis. Hepatology 18:309–314
Shah R, Mahour GH, Ford EG, Stanley P (1990) Partial splenic embolization. An effective alternative to splenectomy for hypersplenism. Am Surg 56:774–777
Brandt CT, Rothbart LJ, Kumpe D, Karrer FM, Lilly JR (1989) Splenic embolization in children: long-term efficacy. J Pediatr Surg 24:642–645
Israel DM, Hassall E, Culham JAG, Phillips RR (1994) Partial splenic embolization in children with hypersplenism. J Pediatr 124:95–100
Ohmagari K, Toyonaga A, Tanikawa K (1993) Effects of transcatheter splenic arterial embolization on portal hypertensive gastric mucosa. Am J Gastroenterol 88:1837–1841
Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classfications: a study of consistency of Ratings. Anesthesiology 49:239–243
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649
Nishida O, Moriyasu F, Nakamura T, Ban N, Miura K, Sakai M, Uchino H, Miyake T (1986) Interrelationship between splenic and superior mesenteric venous circulation manifested by transient splenic arterial occlusion using a balloon catheter. Hepatology 7:442–446
Acknowledgements
Valuable medical and linguistic comments from Dr. John Jorgensen, Sydney, are gratefully acknowledged.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pålsson, B., Hallén, M., Forsberg, A.M. et al. Partial splenic embolization: long-term outcome. Langenbecks Arch Surg 387, 421–426 (2003). https://doi.org/10.1007/s00423-002-0342-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-002-0342-6