Clinical application of partial splenic embolization

Abstract

Partial splenic embolization (PSE) is one of the intra-arterial therapeutic approaches of diseases. With the development of interventional radiology, the applications of PSE in clinical practice are greatly extended, while various materials are developed for embolization use. Common indications of PSE include hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, splenic trauma, idiopathic thrombocytopenic purpura, splenic hemangioma, and liver cancer. It is also performed to exclude splenic artery aneurysms from the parent vessel lumen and prevent aneurysm rupture, to treat splenic artery steal syndrome and improve liver perfusion in liver transplant recipients, and to administer targeted treatment to areas of neoplastic disease in the splenic parenchyma. Indicators of the therapeutic effect evaluation of PSE comprise blood routine test, changes in hemodynamics and in splenic volume. Major complications of PSE include the pulmonary complications, severe infection, damages of renal and liver function, and portal vein thrombosis. The limitations of PSE exist mainly in the difficulties in selecting the arteries to embolize and in evaluating the embolized volume.

Figure 1

Severe cirrhotic liver has been managed with TIPS for relief of portal hypertension. (a) Angiogram shows the small size of cirrhotic liver and the enlarged spleen with abundant peripheral small arteries (arrows) before PSE. (b) The trunk and the lower splenic polar artery have been occluded by stainless steel coils (bold arrows). Arterial phase shows fewer peripheral small arteries in the lower part after embolization. (c) Venous phase of the angiogram before PSE shows the lower part with rich venous blood flow (arrows). (d) Compared with the upper part, the lower part after PSE has very poor venous flow (arrows).

Figure 2

Embolization of the upper and lower polar arteries in combination with achieving peripheral infarction. (a) Arteriogram shows splenomegaly before PSE and abundant peripheral small arteries (arrow). (b) The upper and lower polar arteries have been embolized with coils (arrows). (c) Compared with (a), the peripheral area has scanty arterial branches (arrows).