Abstract No. 633 Trans-splenic access for porto-mesenteric interventions: single-center evaluation of safety and efficacy

Abstract

Treatment of complex portomesenteric pathology (PMP) often requires alternative access sites. This study evaluates the safety and efficacy of endovascular management of PMP via percutaneous trans-splenic access (TSA). A database review of all TSA from 2010-2017 was performed. A total of 36 procedures were performed in 33 patients (18 female, mean age 45, range 2-72). Procedure indication, technical details, technical success (defined as successful access to splenic vein), procedural success, 30-day mortality and major and minor adverse events (AEs) were evaluated. TSA was achieved in all cases using ultrasound guidance and 20g Chiba needle. The splenic vein was accessed in an intrasplenic location. Contrast injection was used to confirm needle access. An .018” wire and Neff sheath was placed (Cook Medical). Depending on the planned intervention the access was then exchanged for the appropriate sized sheath ranging from 4F to 7F. The access tract was embolized using Gelfoam, coils, plugs or nBCA/lipiodol. Clinical indications included: access for TIPS placement or revision (n = 19), variceal embolization (n = 11), portal vein intervention (n = 8), splenic shunt creation (n = 2), and arterioportal fistula embolization (n = 1). Sheath size included: 4F (n = 4), 5F (n = 3), 6F (n = 27), 7F (n = 2). Access site was embolized with Gelfoam (n = 30), coils (n = 2), Amplatzer plug (n = 2), nBCA/Lipiodol (n = 2). Technical success for TSA was 100%. 30-day mortality was 8.3% (n = 3), and was unrelated to access in all cases. Intra-procedural bleeding requiring embolization occurred in 8.3% (n = 3). Post procedure bleeding was seen in 27.7% (n = 10) cases; of these, 13.9% (n = 5) required transfusion. No cases required a secondary embolization procedure. Procedural success was 94.4% (n = 34). Endovascular management of complicated PMP is a challenging task and TSA, although not without risk, is a feasible adjunct tool in the management of these patients.