Abstract
ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.
Highlights
Sinistral portal hypertension (SPH) is characterized by obstruction of the splenic vein leading to isolated gastric varices, mainly due to pancreatic diseases such as pancreatitis and pancreatic tumor [1,2,3,4]
Six patients of the eight patients with chronic pancreatitis, all without a history of gastric bleeding, had gastric varices diagnosed by CT scan, and one of them had hypersplenism; no gastric bleeding was observed during the follow-up after the embolization
We reported our experience implementing partial splenic embolization combined with splenic arterial embolization for sinistral portal hypertension (SPH) patients, in a 2-step protocol
Summary
Sinistral (left-sided) portal hypertension (SPH) is characterized by obstruction of the splenic vein leading to isolated gastric varices, mainly due to pancreatic diseases such as pancreatitis and pancreatic tumor [1,2,3,4]. Collateral circulation from the short gastric vein leads to the dilation of stomach submucosal vessels and subsequently increased blood flow and venous pressure, resulting in isolated gastric varices. These isolated gastric varices are the characteristic clinical feature of SPH, and may cause life-threatening gastric bleeding [2, 5]. The incidence of gastric bleeding in SPH varies from 4 to 72 % [4, 6]
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