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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2021; 5(02): 079-085
DOI: 10.1055/s-0041-1730876
Original Article

Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review

Harriet Grout-Smith   
1   Faculty of Medicine, Imperial College London, London, United Kingdom
,
Ozbil Dumenci   
1   Faculty of Medicine, Imperial College London, London, United Kingdom
,
N. Paul Tait
2   Department of Imaging, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
,
Ali Alsafi 
2   Department of Imaging, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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Abstract

Objectives Sinistral portal hypertension (SPH) is caused by increased pressure on the left portal system secondary to splenic vein stenosis or occlusion and may lead to gastric varices. The definitive management of SPH is splenectomy, but this is associated with significant mortality and morbidity in the acute setting. In this systematic review, we investigated the efficacy and safety of splenic artery embolisation (SAE) in managing refractory variceal bleeding in patients with SPH.

Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies.

Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities.

Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.

Keywords

sinistral portal hypertension - splenic artery embolization - variceal hemorrhage

Notes

*These authors contributed equally to this work.




Publication History

Article published online:
30 June 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Wang L, Liu GJ, Chen YX, Dong HP, Wang LX. Sinistral portal hypertension: clinical features and surgical treatment of chronic splenic vein occlusion. Med Princ Pract 2012; 21 (01) 20-23
    CrossrefPubMedGoogle Scholar
  • 2 Pereira P, Peixoto A. Left-Sided Portal Hypertension: A Clinical Challenge. GE Port J Gastroenterol 2015; 22 (06) 231-233
    CrossrefPubMedGoogle Scholar
  • 3 Thompson RJ, Taylor MA, McKie LD, Diamond T. Sinistral portal hypertension. Ulster Med J 2006; 75 (03) 175-177
    PubMedGoogle Scholar
  • 4 Butler JR, Eckert GJ, Zyromski NJ, Leonardi MJ, Lillemoe KD, Howard TJ. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford) 2011; 13 (12) 839-845
    CrossrefPubMedGoogle Scholar
  • 5 Köklü S, Çoban S, Yüksel O, Arhan M. Left-sided portal hypertension. Dig Dis Sci 2007; 52 (05) 1141-1149
    CrossrefPubMedGoogle Scholar
  • 6 Xie CL, Wu CQ, Chen Y. et al. Sinistral Portal Hypertension in Acute Pancreatitis: A Magnetic Resonance Imaging Study. Pancreas 2019; 48 (02) 187-192
    CrossrefPubMedGoogle Scholar
  • 7 Pandey V, Patil M, Patel R, Chaubal A, Ingle M, Shukla A. Prevalence of splenic vein thrombosis and risk of gastrointestinal bleeding in chronic pancreatitis patients attending a tertiary hospital in western India. J Family Med Prim Care 2019; 8 (03) 818-822
    CrossrefPubMedGoogle Scholar
  • 8 Weledji EP. Benefits and risks of splenectomy. Int J Surg 2014; 12 (02) 113-119
    CrossrefPubMedGoogle Scholar
  • 9 Sakorafas GH, Sarr MG, Farley DR, Farnell MB. The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg 2000; 179 (02) 129-133
    CrossrefPubMedGoogle Scholar
  • 10 Weber SM, Rikkers LF. Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis. World J Surg 2003; 27 (11) 1271-1274
    CrossrefPubMedGoogle Scholar
  • 11 Glynn MJ. Isolated splenic vein thrombosis. Arch Surg 1986; 121 (06) 723-725
    CrossrefPubMedGoogle Scholar
  • 12 Evans GR, Yellin AE, Weaver FA, Stain SC. Sinistral (left-sided) portal hypertension. Am Surg 1990; 56 (12) 758-763
    PubMedGoogle Scholar
  • 13 Liu Q, Song Y, Xu X, Jin Z, Duan W, Zhou N. Management of bleeding gastric varices in patients with sinistral portal hypertension. Dig Dis Sci 2014; 59 (07) 1625-1629
    CrossrefPubMedGoogle Scholar
  • 14 Van der Cruyssen F, Manzelli A. Splenic artery embolization: technically feasible but not necessarily advantageous. World J Emerg Surg 2016; 11 (01) 47-61
    CrossrefPubMedGoogle Scholar
  • 15 Smith M, Ray CE. Splenic artery embolization as an adjunctive procedure for portal hypertension. Semin Intervent Radiol 2012; 29 (02) 135-139
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Guan Y, Ying Hu. Clinical Application of Partial Splenic Embolization. Sci World J 2014;2014.
    PubMed
  • 17 Martin L. Goldman, Philip K. Philip, Mohammad S. Sarraflzadeh, I. James Sarfeh, Atef A. Salam, John T. Galambos, et al.Intraarterial Tissue Adhesive for Medical Splenectomy in Humans.. Radiology 1981; 140
    PubMedGoogle Scholar
  • 18 Fernandes A, Almeida N, Ferreira AM. et al. Left-Sided Portal Hypertension: A Sinister Entity. GE Port J Gastroenterol 2015; 22 (06) 234-239
    CrossrefPubMedGoogle Scholar
  • 19 Wang Q, Xiong B, Zheng C, Liang M, Han P. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients. Cardiovasc Intervent Radiol 2016; 39 (03) 353-358
    CrossrefPubMedGoogle Scholar
  • 20 Petermann A, Chabrot P, Cassagnes L. et al. Hypersplenism due to portal hypertension: retrospective evaluation of 17 patients treated by splenic embolization. Diagn Interv Imaging 2012; 93 (01) 30-36
    CrossrefPubMedGoogle Scholar
  • 21 Luo X, Nie L, Wang Z, Tsauo J, Tang C, Li X. Transjugular endovascular recanalization of splenic vein in patients with regional portal hypertension complicated by gastrointestinal bleeding. Cardiovasc Intervent Radiol 2014; 37 (01) 108-113
    CrossrefPubMedGoogle Scholar
  • 22 Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003; 14 (9 Pt 2) S199-S202
    CrossrefPubMedGoogle Scholar
  • 23 Kokabi N, Lee E, Echevarria C, Loh C, Kee S. Sinistral portal hypertension: presentation, radiological findings, and treatment options - a case report. J Radiol Case Rep 2010; 4 (10) 14-20
    PubMedGoogle Scholar
  • 24 Roesch W, Rexroth G. Pulmonary, cerebral and coronary emboli during bucrylate injection of bleeding fundic varices. Endoscopy 1998; 30 (08) S89-S90
    PubMedGoogle Scholar
  • 25 Thavanathan J, Heughan C, Cummings TM. Splenic vein thrombosis as a cause of variceal bleeding. Can J Surg 1992; 35 (06) 649-652
    PubMedGoogle Scholar
  • 26 Moossa AR, Gadd MA. Isolated splenic vein thrombosis. World J Surg 1985; 9 (03) 384-390
    CrossrefPubMedGoogle Scholar
  • 27 Warshaw AL, Jin GL, Ottinger LW. Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis. Arch Surg 1987; 122 (04) 410-415
    CrossrefPubMedGoogle Scholar
  • 28 Salam AA, Warren WD, Tyras DH. Splenic vein thrombosis: a diagnosable and curable form of portal hypertension. Surgery 1973; 74 (06) 961-972
    PubMedGoogle Scholar
  • 29 Clarke PJ, Morris PJ. Section 43.1: Surgery of the Spleen. In: Morris PJ, Wood WC, editors. Oxford Textbook of Surgery. USA: Oxford University Press, 2000
  • 30 Stein M, Link DP. Symptomatic spleno-mesenteric-portal venous thrombosis: recanalization and reconstruction with endovascular stents. J Vasc Interv Radiol 1999; 10 (03) 363-371
    CrossrefPubMedGoogle Scholar
  • 31 Lankisch PG. The spleen in inflammatory pancreatic disease. Gastroenterology 1990; 98 (02) 509-516
    CrossrefPubMedGoogle Scholar
  • 32 Crary SE, Buchanan GR. Vascular complications after splenectomy for hematologic disorders. Blood 2009; 114 (14) 2861-2868
    CrossrefPubMedGoogle Scholar
  • 33 CIRSE 2014. Cardiovasc Intervent Radiol 2014; 37: 83-373
    CrossrefPubMedGoogle Scholar
  • 34 Fujitani RM, Johs SM, Cobb SR, Mehringer CM, White RA, Klein SR. Preoperative splenic artery occlusion as an adjunct for high risk splenectomy. Am Surg 1988; 54 (10) 602-608
    PubMedGoogle Scholar
  • 35 Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol 2014; 6 (05) 160-168
    CrossrefPubMedGoogle Scholar
  • 36 Koconis KG, Singh H, Soares G. Partial splenic embolization in the treatment of patients with portal hypertension: a review of the english language literature. J Vasc Interv Radiol 2007; 18 (04) 463-481
    CrossrefPubMedGoogle Scholar
  • 37 Rong JJ, Liu D, Liang M. et al. The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis. Mil Med Res 2017; 4: 17
    PubMedGoogle Scholar
  • 38 Ekeh AP, Khalaf S, Ilyas S, Kauffman S, Walusimbi M, McCarthy MC. Complications arising from splenic artery embolization: a review of an 11-year experience. Am J Surg 2013; 205 (03) 250-254
    CrossrefPubMedGoogle Scholar
  • 39 Coldwell DM, Stokes KR, Yakes WF. Embolotherapy: agents, clinical applications, and techniques. Radiographics 1994; 14 (03) 623-643
    CrossrefPubMedGoogle Scholar
  • 40 Hoppe H, Kos S. Splenic Artery Embolization: Proximal or Distal?. Endovascular Today 2018; 17: 73-76
    PubMedGoogle Scholar
  • 41 Imbrogno BF, Ray CE. Splenic artery embolization in blunt trauma. Semin Intervent Radiol 2012; 29 (02) 147-149
    Article in Thieme ConnectPubMedGoogle Scholar