04:12 PM Abstract No. 256 Splenic embolization for splenic arterial steal syndrome

Abstract

Splenic arterial steal syndrome (SASS) is preferential splenic arterial flow with hepatic arterial hypo-perfusion seen on angiography without hepatic arterial anatomical abnormality. The study compares liver Doppler findings before and after splenic embolization 104 patients were treated with splenic arterial embolization (SAE) for various indications in the past seven years at our institution. After IRB approval, we identified patients with SASS as indication for SAE. Paired t-test was performed to compare the available pre and post-embolization hepatic artery peak systolic velocities (PSV), resistive indices (RI) and main portal vein velocities. 11 patients underwent proximal SAE (between the dorsal pancreatic artery and hilum with coils/plugs) for SASS. Liver Doppler findings were compared before and after SAE done to increase liver transplant hepatic arterial flow in 8/11 patients. Main portal vein velocity significantly decreased post SAE [mean 53.1 cm/s (14-98 cm/s) to 31.3 cm/s (14-54 cm/s), p<0.05]. Hepatic artery RI decreased post SAE [mean 0.74 (0.46-0.99) to 0.63 (0.34-0.88), p<0.05]. No significant difference between hepatic artery PSV (p=0.5) was observed after SAE [pre 153.5 cm/s (45-340 cm/s) to post 113.9 cm/s (48-171 cm/s)]. No splenic infarctions or abscesses were identified. Total bilirubin remained stable immediately post procedure (mean 14.4 to 13.9, p=0.4), but decreased one month post-embolization (mean 10.9 to 3.7, p=0.1). Pre-embolization albumin values remained stable immediate and 1 month post procedure. SAE is safe and effective procedure to increase hepatic arterial flow to the transplant liver with SASS. Following SAE for SASS, hepatic artery RI and main portal vein velocity are responsive to the procedure and the liver Doppler may serve as a tool to predict procedural success. Both the decrease in portal venous velocity and hepatic artery RI may support the hepatic arterial buffer response (HABR) theory as a cause or contributor to the SASS