Comparison of three embolic materials at partial splenic artery embolization for hypersplenism: clinical, laboratory, and radiological outcomes

Mohamed M A Zaitoun,Mohamed-Karji Almarzooqi,Hossam A El-Kenawy,Ibrahim M Eladl,Mohammad Abd Alkhalik Basha,Ali M Hendi,Nader Ali Alayouty,Nahla A Zaitoun,Ahmad El-Morsy,Hassan Abdelsalam,Nader E M Mahmoud,Shahenda Shahin,Alaa A Farag,Husain Alturkistani,Dalia Salah El Deen,Ali Hassan Elmokadem,Saeed Bakry Elsayed

doi:10.1186/s13244-021-01030-5

Abstract

PurposeTo compare effectiveness of three widely used embolic agents in partial splenic embolization (PSE) by analyzing their clinical, laboratory, and radiological outcomes within one year of follow-up.Materials and methodsThis retrospective study examined 179 patients who underwent PSE to manage hypersplenism secondary to cirrhosis. Patients were divided into 3 groups according to embolic agent used. Group 1 (gelatin sponge) included 65 patients, group 2 (embospheres) included 58 patients, and group 3 (PVA) included 56 patients. Clinical, laboratory, and radiological outcomes were compared between groups.ResultsThe technical success rate was 100% in all groups. Pain as a major complication was lower in the gelatin sponge group (20%) compared to the embosphere group (31%) and PVA group (32.3%). Major complications other than pain were found in 20.1%; 24.6% in gelatin sponge group, 15.5% in embosphere group and 19.6% in PVA group (p = 0.045). WBCs and platelet counts showed a significant increase after PSE in all groups. Entire splenic volume as measured by computed tomography after PSE showed no significant difference among the 3 groups; however, the volume of infarcted spleen was significantly lower in the gelatin sponge group compared to other two groups (p = 0.001). The splenic span was significantly reduced one-year post-procedure in three groups (p = 0.006), and it was significantly less in embosphere and PVA groups compared to gelatin sponge group (p < 0.05). Recurrent bleeding was higher in gelatin sponge group (p < 0.05).ConclusionsPermanent embolic materials achieved better laboratory and radiological outcomes than gelatin sponge particles in PSE of cirrhotic hypersplenism patients. However, permanent particles were associated with greater abdominal pain.

Highlights

Since its development in 1979, partial splenic embolization (PSE) has been universally accepted to treat patients with hypersplenism in preference to surgical splenectomy [1,2,3,4]
Major complications other than pain were found in 20.1%; 24.6% in gelatin sponge group, 15.5% in embosphere group and 19.6% in polyvinyl alcohol (PVA) group (p = 0.045)
Entire splenic volume as measured by computed tomography after PSE showed no significant difference among the 3 groups; the volume of infarcted spleen was significantly lower in the gelatin sponge group compared to other two groups (p = 0.001)

Summary

Introduction

Since its development in 1979, partial splenic embolization (PSE) has been universally accepted to treat patients with hypersplenism in preference to surgical splenectomy [1,2,3,4]. Partial splenic embolization (PSE) maintained partial splenic function [5] and was thought to be an effective alternative to treat thrombocytopenia and leukopenia resulted from hypersplenism with fewer complications [6, 7]. Various embolic materials have been used for PSE, including temporary agents such as gelatin sponge (Gelfoam) and permanent agents such as polyvinyl alcohol (PVA) particles, trisacrylgelatin microsphere (embospheres), PVA hydrogel beads with an acrylic polymer, hydropearl microspheres, and hydrogel microspheres coated with Polyzene-F [1, 12]. In comparison with gelatin sponge, permanent embolic material as embosphere particles and PVA are smaller and have a specific size range. Unlike PVA particles, which can be oblong, oval, irregular, and sharp, embosphere particles are spherical with smooth margins [18]

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Conclusion