Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review
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 i...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical Publishers, Inc.
2021-06-01
|
| Series: | Journal of Clinical Interventional Radiology ISVIR |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1730876 |
| _version_ | 1818743807776129024 |
|---|---|
| author | Harriet Grout-Smith Ozbil Dumenci N. Paul Tait Ali Alsafi |
| author_facet | Harriet Grout-Smith Ozbil Dumenci N. Paul Tait Ali Alsafi |
| author_sort | Harriet Grout-Smith |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-18T02:34:17Z |
| format | Article |
| id | doaj.art-9a5ec48bf2034b0f964d9b09b41a4ae8 |
| institution | Directory Open Access Journal |
| issn | 2456-4869 |
| language | English |
| last_indexed | 2024-12-18T02:34:17Z |
| publishDate | 2021-06-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Journal of Clinical Interventional Radiology ISVIR |
| spelling | doaj.art-9a5ec48bf2034b0f964d9b09b41a4ae82022-12-21T21:23:49ZengThieme Medical Publishers, Inc.Journal of Clinical Interventional Radiology ISVIR2456-48692021-06-0150207908510.1055/s-0041-1730876Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic ReviewHarriet Grout-Smith0Ozbil Dumenci1N. Paul Tait2Ali Alsafi3Faculty of Medicine, Imperial College London, London, United KingdomFaculty of Medicine, Imperial College London, London, United KingdomDepartment of Imaging, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United KingdomDepartment of Imaging, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United KingdomObjectives 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1730876sinistral portal hypertensionsplenic artery embolizationvariceal hemorrhage |
| spellingShingle | Harriet Grout-Smith Ozbil Dumenci N. Paul Tait Ali Alsafi Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review Journal of Clinical Interventional Radiology ISVIR sinistral portal hypertension splenic artery embolization variceal hemorrhage |
| title | Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review |
| title_full | Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review |
| title_fullStr | Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review |
| title_full_unstemmed | Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review |
| title_short | Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review |
| title_sort | splenic artery embolisation for the emergency treatment of sinistral portal hypertension a systematic review |
| topic | sinistral portal hypertension splenic artery embolization variceal hemorrhage |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1730876 |
| work_keys_str_mv | AT harrietgroutsmith splenicarteryembolisationfortheemergencytreatmentofsinistralportalhypertensionasystematicreview AT ozbildumenci splenicarteryembolisationfortheemergencytreatmentofsinistralportalhypertensionasystematicreview AT npaultait splenicarteryembolisationfortheemergencytreatmentofsinistralportalhypertensionasystematicreview AT alialsafi splenicarteryembolisationfortheemergencytreatmentofsinistralportalhypertensionasystematicreview |