Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism
Background: Partial splenic embolization (PSE) has been proposed in patients with cirrhotic hypersplenism in cases when thrombocytopenia causes clinical manifestations or if there are contraindications to subsequent therapeutic procedures. We provide a retrospective review of the safety and favorabl...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health/LWW
2017-01-01
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| Series: | Formosan Journal of Surgery |
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| Online Access: | http://www.e-fjs.org/article.asp?issn=1682-606X;year=2017;volume=50;issue=3;spage=101;epage=106;aulast=Wu |
| _version_ | 1797703888821813248 |
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| author | Bor-Gang Wu Andy Shau-Bin Chou Guan-Jin Ho Ming-Che Lee |
| author_facet | Bor-Gang Wu Andy Shau-Bin Chou Guan-Jin Ho Ming-Che Lee |
| author_sort | Bor-Gang Wu |
| collection | DOAJ |
| description | Background: Partial splenic embolization (PSE) has been proposed in patients with cirrhotic hypersplenism in cases when thrombocytopenia causes clinical manifestations or if there are contraindications to subsequent therapeutic procedures. We provide a retrospective review of the safety and favorable treatment results of 80% splenic embolization in patients with cirrhotic hypersplenism in our institute.
Methods: Thirteen consecutive patients with cirrhotic hypersplenism were included in a 4-year study period. The indications for PSE were as follows: percutaneous treatment of hepatocellular carcinoma (HCC) (n = 3), transarterial chemoembolization plus hepatic arterial infusion chemotherapy for HCC (n = 2), preparation for major surgery (n = 5), and severe purpura (n = 3). PSE was performed with up to 80% reduction of splenic blood flow by radiological intervention. A tight protocol of prophylactic antibiotics was introduced. Patient demographics, procedure-related complication, and efficacy of PSE were analyzed.
Results: The mean follow-up time was 26.1 ± 12.3 months. All the patients tolerated the procedure. The minor complication of postembolization syndromes such as fever and abdominal pain occurred in 38.5% and 61.5% of patients, respectively. Only a major complication of transient ascites needs diuretic therapy occurred in two patients. Pre-PSE platelet count was 35,077 ± 11,049/mm3, and it significantly increased 1 week after PSE, with a mean increase of platelet count to 384% of pre-PSE level (P < 0.001). The effect of PSE sustained to maintain the platelet count significantly at a mean level of 112,636 ± 33,341/mm3, 114,571 ± 30,696/mm3, and 118,000 ± 31,035/mm3 at 12, 24, and 36 months, respectively.
Conclusion: Our series demonstrated that 80% PSE is a safe and effective method to treat patients with cirrhotic hypersplenism. It could not only increase the platelet count within a short period of time but also maintain it at an acceptable level for a long duration. Under a tight protocol of prophylactic antibiotic and delicate technique of PSE, there was no any septic complication developed in our series. |
| first_indexed | 2024-03-12T05:12:06Z |
| format | Article |
| id | doaj.art-e498e8fede424679ae60d0b199235c6b |
| institution | Directory Open Access Journal |
| issn | 1682-606X |
| language | English |
| last_indexed | 2024-03-12T05:12:06Z |
| publishDate | 2017-01-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Formosan Journal of Surgery |
| spelling | doaj.art-e498e8fede424679ae60d0b199235c6b2023-09-03T08:38:03ZengWolters Kluwer Health/LWWFormosan Journal of Surgery1682-606X2017-01-0150310110610.4103/fjs.fjs_35_17Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenismBor-Gang WuAndy Shau-Bin ChouGuan-Jin HoMing-Che LeeBackground: Partial splenic embolization (PSE) has been proposed in patients with cirrhotic hypersplenism in cases when thrombocytopenia causes clinical manifestations or if there are contraindications to subsequent therapeutic procedures. We provide a retrospective review of the safety and favorable treatment results of 80% splenic embolization in patients with cirrhotic hypersplenism in our institute. Methods: Thirteen consecutive patients with cirrhotic hypersplenism were included in a 4-year study period. The indications for PSE were as follows: percutaneous treatment of hepatocellular carcinoma (HCC) (n = 3), transarterial chemoembolization plus hepatic arterial infusion chemotherapy for HCC (n = 2), preparation for major surgery (n = 5), and severe purpura (n = 3). PSE was performed with up to 80% reduction of splenic blood flow by radiological intervention. A tight protocol of prophylactic antibiotics was introduced. Patient demographics, procedure-related complication, and efficacy of PSE were analyzed. Results: The mean follow-up time was 26.1 ± 12.3 months. All the patients tolerated the procedure. The minor complication of postembolization syndromes such as fever and abdominal pain occurred in 38.5% and 61.5% of patients, respectively. Only a major complication of transient ascites needs diuretic therapy occurred in two patients. Pre-PSE platelet count was 35,077 ± 11,049/mm3, and it significantly increased 1 week after PSE, with a mean increase of platelet count to 384% of pre-PSE level (P < 0.001). The effect of PSE sustained to maintain the platelet count significantly at a mean level of 112,636 ± 33,341/mm3, 114,571 ± 30,696/mm3, and 118,000 ± 31,035/mm3 at 12, 24, and 36 months, respectively. Conclusion: Our series demonstrated that 80% PSE is a safe and effective method to treat patients with cirrhotic hypersplenism. It could not only increase the platelet count within a short period of time but also maintain it at an acceptable level for a long duration. Under a tight protocol of prophylactic antibiotic and delicate technique of PSE, there was no any septic complication developed in our series.http://www.e-fjs.org/article.asp?issn=1682-606X;year=2017;volume=50;issue=3;spage=101;epage=106;aulast=WuCirrhosiscomplicationhypersplenismsplenic embolizationthrombocytopenia |
| spellingShingle | Bor-Gang Wu Andy Shau-Bin Chou Guan-Jin Ho Ming-Che Lee Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism Formosan Journal of Surgery Cirrhosis complication hypersplenism splenic embolization thrombocytopenia |
| title | Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism |
| title_full | Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism |
| title_fullStr | Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism |
| title_full_unstemmed | Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism |
| title_short | Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism |
| title_sort | eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism |
| topic | Cirrhosis complication hypersplenism splenic embolization thrombocytopenia |
| url | http://www.e-fjs.org/article.asp?issn=1682-606X;year=2017;volume=50;issue=3;spage=101;epage=106;aulast=Wu |
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