Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy

Abstract

Background: Splenomegaly is a risk factor for post-splenectomy portal or splenic vein thrombosis (PSVT) due to large splenic vein stump. The relationship between splenic vein diameter (SVD) and PSVT has not been established.

Objectives: To investigate whether SVD is a risk factor for PSVT.

Methods: Forty patients who underwent laparoscopic splenectomy were analyzed. Preoperative and postoperative enhanced helical computed tomographic scans were obtained in all patients, and subsequent follow-up was performed in patients with PSVT during anticoagulant therapy. SVDs at the junction of portal vein (PV) 2, 4, and 6 cm from the junction of PV were measured preoperatively and postoperatively. Multivariate analysis was performed using logistic regression model.

Results: PSVT was diagnosed in 52.5% (21/40) patients. Preoperative SVD was significantly larger in patients with PSVT than in those without PSVT. Seventy-two percent of patients (16/22) with PSVT in splenic veins with a diameter of >8 mm developed PSVT. Multivariate analysis identified preoperative SVD as a significant and independent determinant of PSVT. At a cutoff value of 8 mm, receiver operator characteristic analysis for prediction of PSVT provided an area under the curve of 0.8552 (95% CI 0.821-1.000).

Conclusion: Preoperative SVD is a risk factor for post-splenectomy PSVT. We recommend measurement of SVD preoperatively in patients elected to undergo splenectomy, and a close follow-up of patients with SVD greater than 8 mm.