title: Selective Spleen Embolization of Splenomegaly to Improve Thrombocytopenia Facilitating Open Aortic Aneurysm Repair: A Staged Approach.
abstract: We present an 82-year-old man with a history of hairy cell leukemia, having an 11-cm abdominal aortic aneurysm, who also had severe thrombocytopenia (about 20 000 platelets/μL) and splenomegaly at presentation. The patient had unfavorable anatomy for endovascular aneurysm repair, and therefore, an open procedure was planned. To reduce risk for perioperative bleeding and optimize patient preoperative status, a staged approach was employed. Initially, several sessions of embolization of 2 splenic artery branches were performed with the intent to decrease spleen size and to increase platelet count thus decreasing the perioperative bleeding risk. Then, after successfully increasing platelet count (280 000 PLT/μL), open repair of the aneurysm was conducted. This case demonstrates that selective splenic embolization in patients with hypersplenism and subsequent thrombocytopenia who are in need for major surgery may achieve a significant rise in platelet count and optimize patient's preoperative status in order to avoid bleeding complications.
authors: Department of Vascular Surgery, Red Cross Hospital, Athens, Greece.
authors: Dimitrios
authors: D
authors: Maras
authors: Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, University of Crete Medical School, Heraklion, Crete, Greece.
authors: Nikolaos
authors: N
authors: Kontopodis
authors: Department of Vascular Surgery, Red Cross Hospital, Athens, Greece.
authors: Athansios
authors: A
authors: Dedes
authors: Department of Radiology, Interventional Radiology Unit, Red Cross Hospital, Athens, Greece.
authors: Antonios
authors: A
authors: Tsanis
authors: Department of Vascular Surgery, Red Cross Hospital, Athens, Greece.
authors: Ioannis
authors: I
authors: Mazarakis
authors: Department of Vascular Surgery, Red Cross Hospital, Athens, Greece ioannou@med.uoc.gr.
authors: Christos
authors: C
authors: Gekas
authors: Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, University of Crete Medical School, Heraklion, Crete, Greece ioannou@med.uoc.gr.
authors: Christos V
authors: CV
authors: Ioannou
mesh_terms: D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D000072226:Computed Tomography Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D010976:Platelet Count; D012307:Risk Factors; D012720:Severity of Illness Index; D013157:Splenic Artery / Q000000981:diagnostic imaging; D013163:Splenomegaly / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome
keywords: aortic aneurysm repair; embolization; embolization particles; hairy cell leukemia; splenomegaly; thrombocytopenia