Partial splenic embolization in patients with cirrhosis: efficacy, tolerance and long-term outcome in 32 patients.
BACKGROUND
Although partial splenic embolization (PSE) has been proposed in patients with cirrhosis in cases when thrombocytopenia or neutropenia may cause clinical manifestations or if there are contra-indications to other therapeutic procedures, there are limited data on long-term outcome. We provide a retrospective review of results and the tolerance of all PSE procedures in patients with cirrhosis in our department.


METHODS
Thirty-two consecutive patients with cirrhosis were included over a 6 year period. Indications for PSE were as follows: (1) severe cytopenia preventing necessary antiviral treatment (n=14), percutaneous destruction of hepatocellular carcinoma (n=8) or major surgery (n=3), severe purpura (n=3); (2) painful splenomegaly (n=4). After superselective catheterization, embolization was performed with up to 50% reduction of splenic blood flow.


RESULTS
Thrombocyte and leucocyte counts increased markedly (185% and 51% at 1 month; 95% and 30% at 6 months). Thirty-one and 20 patients had platelet count >80,000/mm3 at months 1 and 6 vs only one before PSE. Overall, the aim of PSE was achieved in 27 patients (84%) (planned treatment: 20/25; disappearance of purpura and splenic pain: 7/7). Severe complications occurred in five patients (16%): transient ascites (n=2), splenic and/or portal vein thrombosis (n=2) that resolved after anticoagulation therapy, and splenic abscess (n=2) leading to death. These two patients had splenic necrosis >70%.


CONCLUSIONS
In patients with cirrhosis, PSE may resolve cytopenia and the clinical complications related to hypersplenism or splenomegaly. However, due to a high risk of severe complications, particularly splenic abscess, the indications of PSE should be very limited and the extent of necrosis should be strictly controlled during the PSE procedure.
N'Kontchou
Gisèle
G
Department of Hepato-gastroenterology, Hôpital Jean Verdier, Bondy Cedex, France. gisele.nkontchou@jvr.ap-hop-paris.fr
Seror
Olivier
O
Bourcier
Valérie
V
Mohand
Djamila
D
Ajavon
Yves
Y
Castera
Laurent
L
Grando-Lemaire
Véronique
V
Ganne-Carrie
Nathalie
N
Sellier
Nicolas
N
Trinchet
Jean-Claude
JC
Beaugrand
Michel
M
D000038:Abscess / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006971:Hypersplenism / Q000209:etiology / Q000628:therapy*; D007970:Leukopenia / Q000209:etiology / Q000628:therapy; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013158:Splenic Diseases / Q000209:etiology; D013163:Splenomegaly / Q000209:etiology / Q000628:therapy*; D013921:Thrombocytopenia / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome