title: Proximal Splenic Artery Embolization in Chemotherapy-Induced Thrombocytopenia: A Retrospective Analysis of 13 Patients.
abstract: OBJECTIVE
  To determine if proximal splenic artery embolization (PSAE) provides a safe and effective alternative to alleviate chemotherapy-induced thrombocytopenia (CIT), allowing patients with cancer to resume chemotherapy regimens.
  
  
  METHODS
  Thirteen patients (9 men, 4 women; mean age, 63 y) with underlying malignancy (pancreatic adenocarcinoma, n = 6; cholangiocarcinoma, n = 5; other, n = 2) complicated by CIT underwent PSAE. Mean platelet counts were calculated before the initiation of chemotherapy, at the nadir that resulted in discontinuation of chemotherapy before the PSAE procedure, at peak values after the procedure, and at a mean follow-up of 9.2 months. The time to reinitiation of chemotherapy after PSAE was calculated.
  
  
  RESULTS
  Baseline platelet count before initiation of chemotherapy was 162 × 10(9)/L (range, 90-272 × 10(9)/L). The platelet count nadir resulting in cessation of chemotherapy was 45 × 10(9)/L (range, 23-67 × 10(9)/L), and the pre-PSAE platelet count was 88 × 10(9)/L (range, 49-131 × 10(9)/L). The post-PSAE peak platelet count improved significantly (to 209 × 10(9)/L; range, 83-363 × 10(9)/L) compared with the nadir counts and the pre-PSAE counts (P < .01) at a mean short-term follow-up of 35 days (range, 7-91 d). The counts at follow-up to 9.2 months (range, 3-15 mo) were 152 × 10(9)/L (range, 91-241 × 10(9)/L). All patients became eligible to resume chemotherapy. The time to initiation of chemotherapy after PSAE averaged 22 days (range, 4-58 d) in 12 patients; one patient declined chemotherapy.
  
  
  CONCLUSIONS
  Proximal splenic artery embolization appears to be safe and effective in alleviating CIT, allowing resumption of systemic chemotherapy. Further studies may help guide patient selection by identifying characteristics that allow a sustained improvement in thrombocytopenia.
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136. Electronic address: sbhatia1@med.miami.edu.
authors.forename: Shivank S
authors.initials: SS
authors.lastname: Bhatia
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136.
authors.forename: Shree
authors.initials: S
authors.lastname: Venkat
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136.
authors.forename: Ana
authors.initials: A
authors.lastname: Echenique
authors.affiliation: Department of Hematology/Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136.
authors.forename: Caio
authors.initials: C
authors.lastname: Rocha-Lima
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136.
authors.forename: Mehul H
authors.initials: MH
authors.lastname: Doshi
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136.
authors.forename: Jason
authors.initials: J
authors.lastname: Salsamendi
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136.
authors.forename: Katuska
authors.initials: K
authors.lastname: Barbery
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136.
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Narayanan
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013157:Splenic Artery / Q000187:drug effects*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents