Hypersplenism due to portal hypertension: Retrospective evaluation of 17 patients treated by splenic embolization - 18/01/12
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Abstract |
Purpose |
The objective of this retrospective study was to analyze the efficacy and morbidity associated with splenic artery embolization for hypersplenism due to portal hypertension (PHT), as a function of the volume of the splenic parenchyma embolized and the type of PHT (due to intrahepatic block or segmental PHT).
Patients and methods |
This study retrospectively included 17 patients with hypersplenism secondary to PHT (intrahepatic block, n=14; segmental, n=3) treated by splenic artery embolization. The splenic volume embolized was estimated by computed tomography (CT) one month after embolization. A clinical assessment and platelet count took place at 7days, 1month and 6months after the embolization.
Results |
In the group with PHT due to intrahepatic block, the mean volume of embolized splenic parenchyma was 63% of the initial volume (range: 30–95%). Six months later, the platelet level had increased by an average of 232%. All patients with fewer than 80,000platelets/mL at 6months had an embolization volume less than 50%. In the segmental PHT group, the mean volume of the embolized parenchyma was 62% of the initial volume (range: 20–95%), bleeding symptoms had disappeared in all patients, and the platelet level exceeded 80,000/mL. Six patients (6/17, 35%) had complications, two minor and four major: two splenic abscesses, one respiratory distress with ascites, and one pancreatitis with ascites. Five of the six complications were observed in patients with a volume of embolized splenic parenchyma more than 70%.
Conclusion |
Our results show that splenic embolization of more than 50% of the parenchyma is effective in the treatment of hypersplenism due to PHT, but that when the embolized volume exceeds 70%, the procedure is associated with considerable morbidity.
Le texte complet de cet article est disponible en PDF.Keywords : Splenic embolization, Hypersplenism, Portal hypertension, Efficacy, Complications, Thrombocytopenia
Plan
Vol 93 - N° 1
P. 30-36 - janvier 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.