Abstract No. 311 - Coil embolization of the splenic artery: long-term impact on splenic volume

Abstract

Purpose Maintenance of splenic function is often a concern when choosing the appropriate treatment for splenic and splenic arterial pathology. Splenic artery embolization is less morbid than splenectomy, but devascularization of the spleen has the potential to have a similar end-result. The purpose of this study is to determine whether coil embolization of the splenic artery results in a significant degree of splenic volume loss based on long-term CT follow-up data. Materials and Methods Between 1/2004 and 1/2012, a total of 148 patients underwent splenic artery embolization at our institution. Of these, 24 patients (13 males, 11 females, mean age 52) had follow-up contrast-enhanced CT imaging greater than 6 months post-procedure. Embolization was performed using coils anywhere from the splenic artery origin to the splenic hilum. The mean time between embolization and last follow up CT was 27.1 months. Pre- and postembolization splenic volumes were calculated with the use of volume rendering software and compared using the paired t-test. Inter-group comparisons were performed using the unpaired t-test. The presence of Howell-Jolly bodies were ascertained on lab tests. Results Splenic artery embolization resulted in a mean splenic volume loss of 15% (p=0.09). Two patients had a splenic volume loss of greater than 50%: one with 67% loss and one with 88% volume loss. The 9 patients with a grade 3-4 splenic laceration demonstrated a 22% mean volume loss compared to 8% in the 15 patients without trauma (p=NS). Patients that underwent distal splenic artery embolization (n=13) demonstrated a 21% volume reduction while patients with proximal embolization (n=11) demonstrated a 4% reduction (p=NS). No patients had Howell-Jolly bodies on most recent lab tests. No splenic abscesses requiring drainage occurred. No patients required repeat embolization or splenectomy. Conclusion Based on CT volumetric analysis, coil embolization of the main splenic artery resulted in only a mild degree of splenic volume loss over the long term, with a mean of 15% decrease in volume.