New strategies for prevention and treatment of splenic artery steal syndrome after liver transplantation.
OBJECTIVE
To explore a prophylactic procedure to prevent splenic artery steal syndrome (SASS), as well as a therapeutic intervention to correct it.


METHODS
Forty-three liver transplant patients were enrolled in a non-randomized controlled trial, with the eligible criterion that the diameter of the splenic artery is more than 5 mm and/or 1.5 times of the diameter of the hepatic artery. The procedure of splenic artery banding was performed in 28 of the 43 patients, with the other 15 patients studied as a control group. SASS and other complications were compared between these two groups. A new therapeutic intervention, temporary incomplete blockade of the splenic artery with a balloon, was performed to treat SASS in this study.


RESULTS
The incidence of SASS was decreased by banding the splenic artery (0/28 vs 5/15, P = 0.006), and the same result was observed in total complications associated with prophylactic procedures (2/28 vs 6/15, P = 0.014). Five patients in the control group developed SASS within 5 d after OLT, 2 of whom were treated by coil embolization of the splenic artery, whereas the other 3 by temporary blockade of the splenic artery. Reappeared or better hepatic arteries with improved systolic amplitude and increased diastolic flow were detected by Doppler ultrasonography in all the 5 patients. Local splenic ischemic necrosis and nonanastomotic biliary stricture were diagnosed respectively in one patient treated by coil embolization, and no collateral complication was detected in patients treated by temporary blockade of the splenic artery.


CONCLUSIONS
SASS should be avoided during the operation by banding the splenic artery. Temporary blockade of the splenic artery is a new safe and effective intervention for SASS.
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309 Hospital of Chinese People's Liberation Army, Beijing 100091, China.
Ji-Yong
JY
Song
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309 Hospital of Chinese People's Liberation Army, Beijing 100091, China.
Bing-Yi
BY
Shi
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309 Hospital of Chinese People's Liberation Army, Beijing 100091, China.
Zhi-Dong
ZD
Zhu
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309 Hospital of Chinese People's Liberation Army, Beijing 100091, China.
De-Hua
DH
Zheng
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309 Hospital of Chinese People's Liberation Army, Beijing 100091, China.
Gang
G
Li
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309 Hospital of Chinese People's Liberation Army, Beijing 100091, China.
Li-Kui
LK
Feng
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309 Hospital of Chinese People's Liberation Army, Beijing 100091, China.
Lin
L
Zhou
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309 Hospital of Chinese People's Liberation Army, Beijing 100091, China.
Tian-Tian
TT
Wu
Ji-Yong Song, Bing-Yi Shi, Zhi-Dong Zhu, De-Hua Zheng, Gang Li, Li-Kui Feng, Lin Zhou, Tian-Tian Wu, Guo-Sheng Du, Organ Transplant Institute, the 309 Hospital of Chinese People's Liberation Army, Beijing 100091, China.
Guo-Sheng
GS
Du
D000328:Adult; D021721:Balloon Occlusion / Q000009:adverse effects; D002681:China / Q000453:epidemiology; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008026:Ligation; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*
Angiography; Liver transplantation; Organ transplantation; Splenic artery steal syndrome; Vascular complication