Repeated partial splenic artery embolization for hypersplenism improves platelet count

Abstract

Splenic embolization is a minimally invasive alternative to splenectomy for the treatment of hypersplenism. This was a retrospective study of 101 patients with hypersplenism caused by cirrhosis who were treated with splenic embolization and for whom 6 months of follow-up data were available. Of these patients, 65 underwent partial splenic artery embolization (PSE), including 23 who underwent repeated PSE (RPSE). The incidence of abdominal pain was significantly higher in the PSE group than in the total splenic artery embolization (TSE) group (P < 0.001), and its duration was also longer in the PSE group (P = 0.003). Biochemical markers of liver function were compared before and after the operation; aminotransferase indices decreased (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase), total bilirubin increased slightly, and albumin and prealbumin decreased after the operation (all P < 0.001). Platelet (PLT) counts began to increase at 1 week postoperatively, peaked at 1 month postoperatively, and then decreased gradually. There was no significant intergroup (PSE and TSE) difference at any time point (1 day, 1 week, 1 month, and 6 months postoperatively, P > 0.05). There was a significant intergroup (PSE and RPSE) difference in the mean postoperative change in PLT count (P = 0.45). Splenic embolization can improve the inflammatory indicators of liver function. Performing PSE twice or more improves the PLT counts.

Keywords: liver function; partial splenic embolization; platelet count; side effect; splenic abscess.

Figure 1

A flowchart of the study.

Figure 2

A 65-year-old woman with hepatitis B cirrhosis and hypersplenism underwent twice PSE. (a) Digital arteriography showed superior splenic artery branch (arrow) and inferior pole splenic artery branch (hollow arrow). (b) Splenomegaly (arrow). (c) First embolization of superior splenic artery (arrow). (d) One month after the first PSE, low-density infarct area was found in spleen (arrow). (e) The second PSE embolized the inferior splenic artery (arrow). (f) One year later, the spleen shrank (arrow).

Figure 3

Changes of blood cells before and after PSE and TSE. (a) Changes of HB before and after PSE and TSE. (b) Changes of WBC counts before and after PSE and TSE. (c) Changes of PLT counts before and after PSE and TSE. HB: hemoglobin; MCV: mean corpuscular volume; MPV: mean platelet volume; HMT: hematocrit; LPR: large platelet ratio.