Transradial approach for partial splenic embolization in patients with hypersplenism.
OBJECTIVE
Transradial vascular intervention for heart disease has been expanding recently because it is less invasive, but this approach has only been used to treat abdominal disease at a few institutions. Since 2000, we have performed partial splenic embolization (PSE) via the transradial approach with the aim of achieving the least invasive procedure possible.


METHODS
During the past five years, transradial abdominal angiography was performed in 426 patients and eight of them (two men and six women undergoing PSE for LC) were included in this study. They ranged from 48 years to 72 years in age, consisting of three patients in Child class A and five in Child class B. To perform transradial partial splenic embolization, a 4-Fr sheath was inserted in the left radial artery. Under fluoroscopy, intrasplenic branches of the splenic artery supplying about 60-70% of the parenchyma of the spleen were selected and embolized with a newly developed transradial catheter inserted along a guide wire running through the descending aorta. After treatment, the puncture site was compressed by applying a tourniquet. No restriction on movement of the lower or upper extremities is required and the patient is allowed to walk freely.


RESULTS
Transradial embolization was successful in all 8 patients. The procedure required 70 minutes on average. The mean platelet count was 3.3x10(4)/microL before treatment, and it increased to 16.3x10(4) and 11.3x10(4)/microL after two weeks and three months, respectively. All patients suffered from fever and pain after treatment, which were treated conservatively. Occlusion of the radial artery, digital paralysis, or splenic abscess did not occur in any patient.


CONCLUSIONS
This transcatheter technique facilitates hemostasis and requires neither shaving of hair nor insertion of a urinary catheter. In addition, no restriction on movement is needed after the procedure. Consequently, this minimally invasive transradial approach is highly satisfactory for patients and should become a first-line approach for PSE.
Naritaka
Yoshihiko
Y
Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan. narisu@dnh.twmu.ac.jp
Shiozawa
Shunichi
S
Shimakawa
Takeshi
T
Wagatsuma
Yoshihisa
Y
Tsuchiya
Akira
A
Kim
Dal Ho
DH
Isohata
Noriyuki
N
Asaka
Shinichi
S
Yoshimatsu
Kazuhiko
K
Katsube
Takao
T
Ogawa
Kenji
K
D000368:Aged; D002404:Catheterization; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005355:Fibrosis / Q000628:therapy; D006801:Humans; D006971:Hypersplenism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D013154:Spleen / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome