title: Splenic artery embolization: a single center experience on the safety, efﬁcacy, and clinical outcomes.
abstract: OBJECTIVE
  We aimed to assess the safety, efficacy, and clinical outcomes of splenic artery embolization (SAE).
  
  
  METHODS
  A total of 50 patients (male:female, 33:17; mean age, 49 years) who underwent 50 SAEs between 1998 and 2011 were retrospectively studied. The procedure indications included aneurysm or pseudoaneurysm (n=15), gastric variceal hemorrhage (n=15), preoperative reduction of surgical blood loss (n=9), or other (n=11). In total, 22 procedures were elective, and 28 procedures were urgent or emergent. The embolic agents included coils (n=50), gelatin sponges (n=15), and particles (n=4). The measured outcomes were the technical success of the procedure, efficacy, side effects, and the 30-day morbidity and mortality rates.
  
  
  RESULTS
  All embolizations were technically successful. The procedure efficacy was 90%; five patients (10%) had a recurrent hemorrhage requiring a secondary intervention. Side effects included hydrothorax (n=26, 52%), thrombocytosis (n=16, 32%), thrombocytopenia (n=13, 26%), and postembolization syndrome (n=11, 22%). Splenic infarcts occurred in 13 patients (26%). The overall and procedure-specific 30-day morbidity rates were 38% (19/50) and 14% (splenoportal thrombosis, 3/50; encapsulated bacterial infection, 1/50; splenic abscess, 1/50; femoral hematoma requiring surgery, 1/50; hydrothorax requiring drainage, 1/50). The overall and procedure-specific 30-day mortality rates were 8% (4/50) and 0%. The multivariate analysis showed that advanced patient age (P = 0.037), postprocedure thrombocytopenia (P = 0.008), postprocedure hydrothorax (P = 0.009), and the need for a secondary intervention (P = 0.004) predicted the 30-day morbidity, while renal insufficiency (P < 0.0001), preprocedure hemodynamic instability (P = 0.044), and preprocedure leukocytosis (P < 0.0001) were prognostic factors for the 30-day mortality.
  
  
  CONCLUSIONS
  SAE was performed with high technical success and efficacy, but the outcomes showed nontrivial morbidity rates. Elderly patients with thrombocytopenia and hydrothorax after SAE, and patients who require secondary interventions, should be monitored for complications.
authors.affiliation: Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Katz
authors.forename: Ahmad
authors.initials: A
authors.lastname: Parvinian
authors.forename: Steven
authors.initials: S
authors.lastname: Reich
authors.forename: Benedictta O
authors.initials: BO
authors.lastname: Omene
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Yap
authors.forename: Charles A
authors.initials: CA
authors.lastname: Owens
authors.forename: M Grace
authors.initials: MG
authors.lastname: Knuttinen
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
mesh_terms: D000783:Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006876:Hydrothorax / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D013157:Splenic Artery / Q000000981:diagnostic imaging*; D013158:Splenic Diseases; D013921:Thrombocytopenia / Q000000981:diagnostic imaging / Q000209:etiology; D013922:Thrombocytosis / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media