title: Partial splenic embolization in patients with cirrhosis: efficacy, tolerance and long-term outcome in 32 patients.
abstract: 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.
authors.affiliation: Department of Hepato-gastroenterology, Hôpital Jean Verdier, Bondy Cedex, France. gisele.nkontchou@jvr.ap-hop-paris.fr
authors.forename: Gisèle
authors.initials: G
authors.lastname: N'Kontchou
authors.forename: Olivier
authors.initials: O
authors.lastname: Seror
authors.forename: Valérie
authors.initials: V
authors.lastname: Bourcier
authors.forename: Djamila
authors.initials: D
authors.lastname: Mohand
authors.forename: Yves
authors.initials: Y
authors.lastname: Ajavon
authors.forename: Laurent
authors.initials: L
authors.lastname: Castera
authors.forename: Véronique
authors.initials: V
authors.lastname: Grando-Lemaire
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ganne-Carrie
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sellier
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Trinchet
authors.forename: Michel
authors.initials: M
authors.lastname: Beaugrand
mesh_terms: 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