Partial splenic embolization using polyvinyl alcohol particles for hypersplenism in cirrhosis: a prospective randomized study.
OBJECTIVE
To prospectively evaluate the efficacy and safety of partial splenic embolization (PSE) using polyvinyl alcohol (PVA) particles for hypersplenism in cirrhosis, as compared to PSE using gelfoam particles.


METHODS
PSE was performed in 60 consecutive patients with hypersplenism caused by cirrhosis. The patients were randomly assigned into 2 groups: gelfoam group, 32 patients received PSE using gelfoam particles as the embolic material; PVA group, 28 patients received PSE using PVA particles. The follow-up contents included peripheral blood cell counts (leukocyte, platelet and red blood cell) and complications associated with PSE.


RESULTS
Prior to PSE, there was no significant difference between the two groups in sex, age, Child-Pugh grade, the extent of embolization and peripheral blood cell counts. After PSE, no matter in which group, leukocyte and platelet counts kept significantly higher than pre-PSE during the 3-year follow-up period (P<.0001), but the post-PSE improvement of leukocyte and platelet counts was significantly better in PVA group than in gelfoam group (P<.05). Red blood cell counts showed no remarkable changes after PSE (P>.05). Severe complications occurred in 8 patients (25.0%) in gelfoam group and 6 patients (21.4%) in PVA group (P>.05), but the degree of abdominal pain was higher in the latter than in the former (P<.05). Among 17 patients who received more than 70% embolization of spleen, 10 (58.8%) developed severe complications, while among 43 patients who received 70% or less embolization of spleen, only four (9.3%) had severe complications. This difference was statistically significant (P<.05).


CONCLUSIONS
PVA particles could be used as the embolic material in PSE; in comparison with PSE using gelfoam particles, PSE using PVA particles can achieve even better efficacy in alleviating hypersplenism, but the extent of embolization should be strictly limited to not more than 70% of splenic volume.
Zhu
Kangshun
K
Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong Province 510630, China. zhksh010@163.com
Meng
Xiaochun
X
Li
Zhengran
Z
Huang
Mingsheng
M
Guan
Shouhai
S
Jiang
Zaibo
Z
Shan
Hong
H
D000328:Adult; D000792:Angiography; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006801:Humans; D006971:Hypersplenism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011142:Polyvinyl Alcohol / Q000627:therapeutic use*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D011142:Polyvinyl Alcohol