Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation.
OBJECTIVE
To review some aspects of the problem of splenic artery steal syndrome as cause of ischemia in transplanted livers and treatment by selective splenic artery occlusion.


METHODS
Eleven liver transplant patients from a group of 350 patients, nine men and two women, ranging in age from 40 years to 61 years (mean 52 years), presented with biochemical evidences of liver ischemia and failure, ranging from one to 60 days following orthotopic liver transplantation. Diagnosis of splenic artery steal syndrome was suspected by elevated enzymes, Doppler ultrasound and confirmed by celiac angiogram. Patients with confirmed hepatic artery thrombosis before angiography were excluded from the study. Embolization with Gianturco coils was performed.


RESULTS
All patients were treated by splenic artery embolization with Gianturco coils. The 11 patients improved clinically within 24 hours of the procedure with significant change in the biochemical and clinical parameters. Followup ranged from one month to two years. One of the 11 patient initially improved, but developed hepatic artery thrombosis within 24 hours of the embolic treatment, requiring surgical repair.


CONCLUSIONS
Splenic artery steal syndrome following liver transplantation surgery can be diagnosed by celiac angiography, and effectively treated by splenic artery embolization with coils. Embolization is one of the treatments available, it is minimally invasive, and leads to immediate clinical improvement. Hepatic artery thrombosis is a possible complication of the procedure.
Uflacker
Renan
R
Interventional Radiology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA. uflacker@musc.edu
Selby
J Bayne
JB
Chavin
Kenneth
K
Rogers
Jeffrey
J
Baliga
Prabhakar
P
D000328:Adult; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D002404:Catheterization; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy*; D008102:Liver Circulation; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D016031:Liver Transplantation / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000098:blood supply*; D013157:Splenic Artery / Q000000981:diagnostic imaging*; D013577:Syndrome