Partial Splenic Artery Embolization for the Management of Symptomatic Hypersplenism in Portal Hypertension: Clinical Insights from a Case Series

Abstract

Background and AimsPartial splenic artery embolization (PSAE) is an alternative treatment modality for managing hypersplenism secondary to portal hypertension. We are presenting a case series of patients with portal hypertension who underwent PSAE for symptomatic hypersplenism. MethodsWe included patients with portal hypertension who underwent PSAE from January 2022 to December 2022. Patients` characteristics and procedure related complications were noted. Data were analysed for improvement in the hematological parameters. ResultsA total of 11 (7 women, median age 34 [18-56] years) patients were included. Three patients were cirrhotic (Hepatitis B-2, Metabolic dysfunction associated steatohepatitis -1) and 8 were non-cirrhotic (Extra-hepatic portal vein obstruction-5, Non cirrhotic portal fibrosis-3). Splenic artery aneurysm was concomitantly present in 5 cases. Technical success was achieved in all cases. Post embolization, hemoglobin, white blood cells and platelet counts improved at 4 weeks, 12 weeks and 24 weeks along with symptomatic improvement. All patients had post-embolization syndrome. One patient developed transient ascites and secondary bacterial peritonitis which was managed conservatively. Mortality was seen in 1 case secondary to splenic abscess and septicaemia. ConclusionAlthough, haematological parameters and symptoms improve post procedure, PSAE is associated with major complications and should be performed judiciously in selected cases only. Graphical abstract is presented in Figure 1.