03:45 PM Abstract No. 78 Closure of transsplenic access tracts using microfibrillar collagen: success, clinical outcomes, and complications

Abstract

To report clinical experience with transsplenic vascular access closure using microfibrillar collagen (Avitene, Bard; Murray Hills, NJ). 24 patients, mean age 52 years (range: 1.5-75), underwent 26 transsplenic vascular access procedures over 4 years in this retrospective study. Comorbidities, active hemorrhage, anticoagulation, hemoglobin, INR, platelets, prior TIPS, and variceal classification were recorded. Indications for transsplenic access, needle gauge, sheath size, variceal embolization method, tract embolization method, major/minor bleeding complications, and follow-up hemoglobins were recorded. Pre-procedure comorbidities included portal hypertension (n=19,79%), portal vein thrombosis (n=16,67%), hemorrhage (n=8,33%), splenic vein thrombosis (n=7,29%), anticoagulation (n=3,12.5%), and sinistral portal hypertension (n=2,8%). Mean baseline hemoglobin was 9.4 (range:6.3-13), INR 1.3 (range:1-1.9), and platelets 122 (range:18-492). 1 patient had prior TIPS (3.8%). Most common transsplenic access indications were gastric varices with non-patent portosystemic shunt (n=10,38%) and portal vein targeting for TIPS (n=8,30%). One transsplenic access was intentionally arterial. Most common access needle was 22-gauge (n=16,62%); and sheath size, 4-French (n=7,27%) and 6-French (n=7,27%). 13 procedures (50%) involved variceal embolization. Transsplenic tracts were embolized with microfibrillar collagen (n=8), coils and microfibrillar collagen (n=9), or other (n=9). Microfibrillar collagen tract embolizations included 1 major and 2 minor (18%) complications: one splenic artery pseudoaneurysm requiring embolization, and two self-limiting splenic bleeds requiring small-volume blood transfusion. 4 minor (44%) bleeds occurred in 9 tract embolizations without microfibrillar collagen. Transsplenic access tract embolization with microfibrillar collagen is an alternative method to achieve tract hemostasis. In a high-risk patient population, vigilance is necessary to treat potential complications.