Clinical

Partial splenic embolization an option in select patients with cirrhosis

Last Updated: 2005-03-31 15:00:30 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Partial splenic embolization (PSE) can improve severe thrombocytopenia or leucopenia in patients with cirrhosis-related hypersplenism or splenomegaly, investigators report in the February issue of the European Journal of Gastroenterology and Hepatology.

However, they warn that "severe and potentially" fatal complications may occur in a significant number of patients.

Dr. Gisele N'Kontchou and colleagues from Hopital Jean Verdier in Bondy, France, took a look back at 32 patients with cirrhosis who underwent PSE at the institution over a 6-year period.

Indications for the procedure were severe cytopenia preventing antiviral treatment (n=14), percutaneous destruction of hepatocellular carcinoma (n=8) or major surgery (n=3), severe purpura (n=3), and painful splenomegaly (n=4).

"After superselective catheterization, embolization was performed with up to 50% reduction of splenic blood flow," the team reports.

In the majority of patients, thrombocyte and leucocyte counts increased markedly and remained high enough to permit treatment.

Overall, the initial goal of PSE was achieved in 27 patients (84%). Specifically, 20 of 25 were able to undergo planned treatment and 7 of 7 had resolution of purpura and splenic pain.

However, severe complications occurred in 5 of the 32 patients (16%), "four of them in patients with a ratio of splenic necrosis above 70%," the team notes. Splenic abscess was the most severe complication, occurring in two patients after PSE and leading to death in both.

The team concludes, based on this retrospective case series, that, "in patients with cirrhosis, PSE may resolve cytopenia and the clinical complications related to hypersplenism or splenomegaly."

"However, due to a high risk of severe complications, particularly splenic abscess, the indications of PSE should be very limited and the extent of necrosis should be strictly controlled during the PSE procedure," they warn.

Eur J Gastroenterol Hepatol 2005;17:179-184.