Efficacy Of Partial Splenic Embolization Research Articles

Partial Splenic Embolization in Paediatric Sickle Cell Disease Patients with Hypersplenism.

To assess the safety and efficacy of partial splenic embolization (PSE) to reduce the need of transfusions and improve hematologic parameters in patients with hypersplenism and sickle cell disease (SCD). This prospective study includes 35 homozygous hemoglobin S patients with SCD and hypersplenism who underwent PSE from 2015 until 2021 in Kinshasa. Patients were evaluated, before and after PSE (1, 3 and 6months), using clinical, laboratory and ultrasonographic methods. PSE was performed with the administration of gelatin sponge particles embolizing 60-70% of the splenic parenchyma. The mean age was 10 (± 4) years and (21/35, 60%) were male. After PSE Leucocytes decreased at 3 months (16 692.94 vs 13 582.86, p = 0.02) and at six months Erythrocytes increased 2 004 000 vs. 2 804 142 (p < 0.001), Platelets increased (168 147 vs. 308 445, p < 0.001) and Hemoglobin increased (5.05g/dL vs. 6.31g/dL, p < 0.001) There was a significant dicrease in the need of transfusions from 6 (2-20) before PSE to 0.06 (0-1) after PSE (p < 0.001). The most frequent complication was splenic rupture (4/35, 11.4%), seen only and in all patients with hypoechogenic nodules at baseline. PSE is a safe procedure in patients with SCD and hypersplenism, that do not have hypoechogenic nodules in the spleen. PSE improves the hematological parameters and reduces the frequency of blood transfusions.

Partial splenic embolization combined with endoscopic therapies and vasoconstrictive drugs reduces rebleeding in cirrhosis patients with acute variceal bleeding and hypersplenism: a multicenter randomized controlled trial.

This study aimed to compare the efficacy of partial splenic embolization (PSE) combined with endoscopic therapy and endoscopic therapy alone in cirrhosis patients with acute variceal bleeding (AVB) and hypersplenism. Cirrhosis patients with AVB who visited three hospitals from June 2016 to June 2022 were prospectively enrolled and randomly allocated to either the endoscopic therapy combined with PSE group (EP group) or the endoscopic intervention group (E group) in a 1:1 ratio. The primary endpoint of the study was re-bleeding of varices during follow-up, and the secondary endpoints were the recurrence of varices, death, and adverse events. One hundred and fourteen patients were prospectively included, of whom 110 completed the trial. The risk of variceal re-bleeding (19.3% vs. 40.4% (23/57), p = 0.013) and variceal recurrence (28.1% vs. 63.2%, p < 0.001) five years after treatment was significantly lower in the EP group than in the E group, and the EP treatment was the only significant independent risk factor affecting variceal re-bleeding and variceal recurrence in patients. The mortality rate was comparable between the EP and E groups. Peripheral blood counts and liver function all improved significantly in the EP group compared to the E group during the follow-up (p < 0.05). The rates of variceal re-bleeding and recurrence were significantly lower in cirrhosis patients with AVB and hypersplenism after combined endoscopic and PSE treatment compared to those who were provided endoscopic treatment only. The peripheral blood counts and liver function were also improved significantly in EP group (NCT02778425).

Efficacy of Partial Splenic Embolization in the Management of Refractory Immune Thrombocytopenia

Introduction: An increasing number of medical therapies has improved the outcomes of patients with immune thrombocytopenia (ITP), yet a small percentage fail to respond even to multiple medications. While splenectomy can be effective for such refractory cases, it is a less attractive option given its associated surgical morbidity and infectious complications. Partial splenic embolization (PSE) has been proposed as a less invasive and potentially less immunosuppressive procedure which could raise the platelet (Plt) count even after multiple medical therapies have failed. Herein, we aim to report the efficacy of PSE in a contemporary cases series at 2 large academic centers. Methods: We retrospectively identified adult patients who had undergone PSE for refractory ITP between March 2018 and Dec 2021. Demographics, comorbid conditions, and prior medical therapies for ITP were obtained from direct chart review. Clinical workup was reviewed to confirm the diagnosis of refractory ITP including elevated immature platelet fraction (IPF), negative disseminated intravascular coagulopathy (DIC) labs, and negative viral studies. Plt count at baseline, prior to procedure and following PSE were recorded at 1 week, 1 month, 3 months, 6 months, 9 months, and 12 months. A partial response (PR) was defined as Plt increase > 30,000/µL and a complete response (CR) was defined as a Plt increase > 100,000/µL following PSE. Results: A total of 6 patients were identified (median age 62, range 23-69, all patients were males, 5 white and 1 Hispanic). All patients were admitted for management of thrombocytopenia at the time of PSE. 5/6 had presented or developed bleeding complications, with 3/6 having mild symptoms (petechiae, hematoma, epistaxis), 2/6 gastrointestinal bleeding, and no intracranial bleeding. No patients required rapid increase in Plt for an urgent procedure. PSE was pursued in 2 patients with cirrhosis as a comorbidity, which was thought to be contributing to splenomegaly and thrombocytopenia. Despite cirrhosis, a separate diagnosis of ITP was documented due to acute drop in plt count and additional clinical work-up. Median Plt count prior to PSE was 4,000 (interquartile range [IQR] 2-15, range 1-45). All patients had received glucocorticoids and at least one thrombopoietin receptor agonist, 5/6 had received intravenous immunoglobulin (IVIG), 4/6 had received rituximab and 1/6 had also received cyclosporine. At 1 week following PSE, 1/6 had achieved a PR and 2/6 had achieved CRs for an overall response rate (ORR) of 50%. Plt continued to increase in all subjects within a month, and CRs were achieved in 5/6 patients and a PR in the remaining subject (Table 1 & Figure 1). The ORR at 1 month was 100% and the median peak Plt was 242,000/µL (range 93-655). Primary adverse events following PSE were mild and included either abdominal pain or diarrhea in all patients. Conclusions: Overall, PSE for management of ITP is rarely utilized in clinical practice. Our small case series highlights the overall effectiveness of this procedure in refractory cases. This series demonstrates PSE as a safe and effective method of treating ITP in cases refractory to medical management. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract No. 555 Partial splenic embolization in patients with myelodysplastic syndrome and myelofibrosis

Myelodysplastic syndrome (MDS) and myelofibrosis (MF) can present with severe thrombocytopenia with hypersplenism/splenomegaly which can lead to spontaneous life-threatening intracranial or visceral bleed. MDS/MF patients can also have portal hypertension and compressive symptoms due to extreme splenomegaly. Partial splenic embolization can lead to splenic size reduction and platelet count improvement. The purpose of this study was to evaluate the safety and efficacy of partial splenic embolization in MDS/MF patients.

Bevacizumab Does Not Influence the Efficacy of Partial Splenic Embolization in the Management of Chemotherapy-Induced Hypersplenism

BackgroundAntiangiogenics attenuate chemotherapy-related hepatotoxicity and portal hypertension. The potential impact of bevacizumab on the efficacy and safety of partial splenic embolization (PSE) in the management of chemotherapy-induced hypersplenism (CIH) has never been investigated. Patients and MethodsWe conducted a retrospective study with gastrointestinal cancer patients who have undergone PSE for the treatment of thrombocytopenia resulting from hypersplenism. Pre- and post-PSE platelet count (PC), the percentage of patients who resumed systemic therapy, and complication rates were compared between patients exposed and not exposed to bevacizumab. ResultsA total of 110 patients were eligible. Colorectal cancer was the predominant neoplasm (60%), and 5-fluorouracil, oxaliplatin, and bevacizumab were the most commonly provided drugs (70%, 65%, and 65% of patients, respectively). After PSE, 80% of patients recovered PC ≥ 100 × 109/L (100K). Systemic therapy was resumed in 81% of patients. Seventy-one patients exposed to bevacizumab had a median PC before PSE of 77.5K and after PSE of 167.0K, with a mean difference of 108K (P < .0001). Thirty-nine patients not exposed to bevacizumab had a median PC of pre-PSE of 73.0K and post-PSE of 187.0K, with a mean difference of 117.7K (P < .0001). Both groups had similar values of percentages of patients with PC post-PSE ≥ 100K (83% vs. 74%; P = .463), resumption of systemic therapy (85% vs. 74%; P = .213), and complication rates. A linear association between splenic infarction rate and increment in PC was found (P < .0001). ConclusionPSE is a safe and effective procedure in the management of CIH, regardless of the provision of bevacizumab. Splenic infarction rate should be optimized to enhance patient outcomes.

Partial Splenic Artery Embolization in 35 Cancer Patients: Results of a Single Institution Retrospective Study

PurposeTo evaluate the safety and efficacy of partial splenic embolization (PSE) in cancer patients with different etiologies of splenomegaly/hypersplenism. Materials and MethodsThe medical records of 35 cancer patients who underwent 39 PSE procedures were analyzed. The splenomegaly/hypersplenism was due to chemotherapy (n = 17), portal hypertension (n = 10), or hematologic malignancy (n = 8). After the first 11 PSEs, celiac plexus neurolysis, corticosteroids, and non-steroid anti-inflammatory drugs (NSAIDs) were included in the post-procedural management. ResultsPSE led to 59 ± 16% (mean ± standard deviation) splenic infarcts. The infarct volume per 1 mL 300–500 μm tris-acryl gelatin microspheres was not significantly different between the chemotherapy-induced group (264 ± 89 cm3) and the portal hypertension group (285 ± 139 cm3) but was significantly higher in the hematology group (582 ± 345 cm3). Platelet count increased from 65.7 ± 19.7 k/μl to a peak platelet count of 221 ± 83 k/μl at 2 weeks after PSE. Patients with a follow-up period of more than 1 year had the most recent platelet count of 174 ± 113 k/μl. Platelet count increase was significantly higher in the chemotherapy-induced group than the portal hypertension group. Adding celiac plexus neurolysis, corticosteroids, and NSAIDs to the post-procedural management resulted in a decreased rate of major complications from 73% to 46% and a decrease in the rate of moderate or severe pain from 92% to 20%. ConclusionsPSE improved platelet counts in cancer patients despite different etiologies of splenomegaly. The addition of celiac plexus neurolysis, corticosteroids, and NSAIDS to the post-PSE treatment protocol reduced complications. Data from this study could help to predict the amount of 300–500 μm tris-acryl gelatin microspheres required to achieve a planned infarct size.

Abstract No. 436 Partial splenic embolization for thrombocytopenia recovery to facilitate chemotherapy

To evaluate the efficacy of partial splenic embolization for the treatment of thrombocytopenia in patients with metastatic disease prior to, or following, initiation of chemotherapy. Retrospective review was performed on 22 patients in a single institution over a 57 month time period (Nov. 2012 to Aug. 2017) who presented with metastatic disease and thrombocytopenia prior to, or following, initiation of chemotherapy. Malignancies consisted of pancreatic (11), colorectal (8), hepatocellular (1), gastric (1) and cholangiocarcinoma (1). Partial splenic embolization was performed by 1 of 6 operators using particles (300-500 or 500-700 micron) and pre- and postprocedure platelet counts were recorded. In addition, the time to recovery of platelet counts was recorded, thus allowing for initiation or continuation of chemotherapy. Postprocedural complications were monitored. Technical success for partial splenic embolization was 100%. No immediate complications were noted. Average preprocedure platelet count was 84 (range, 60-141). Following partial splenic embolization, average postprocedure platelet count was 272 (126-459) and average time to platelet recovery was 23 days (7-62). When calculated as a percentage of platelet count increase from baseline, the average percentage of platelet count recovery was 246% (78-629%). No major complications were noted with the primary minor complication reported as pain. One patient had persistent pain 5 weeks postprocedure requiring narcotics. No hospitalizations for pain control reported. Partial splenic embolization appears to demonstrate a favorable response in the recovery of thrombocytopenia in patients with metastatic disease. Recovery of platelet counts appears to be within a reasonable timeframe and allows for the safe initiation, or continuation, of systemic chemotherapy in this patient cohort with minimal delay to treatment. Overall complication profile is low.

3:27 PM Abstract No. 402 Partial splenic artery embolization in 35 cancer patients

Thrombocytopenia in cancer patients often contraindicates chemotherapy and/or surgery leading to suboptimal therapy and decreased overall survival. The purpose of our study was to determine safety and efficacy of partial splenic embolization to improve platelet count and to establish a standardized treatment plan to achieve ideal embolization endpoint and minimize postprocedural complications. Medical records of 35 cancer patients who underwent 39 splenic artery embolizations with 300-500 μm Embospheres were analyzed. The target embolization endpoint was 50-70% splenic infarct. Celiac plexus block was performed following 25 procedures for pain control. The spleen volumes were 1337 ± 1038 mL. The embolization led to 59 ± 16% splenic infarct. One mL of microspheres resulted in 272 ± 107 mL splenic infarct in patients with chemotherapy- or portal hypertension-induced splenomegaly and 582 ± 3 45 mL infarct in patients with hematologic malignancies. The spleen volumes decreased by 40.5 ± 11% in 1 year. The platelet count increased from 63.9 ± 29.6 (mean ± SD) to peak platelet count of 248 ± 118 in 2-4 weeks after embolization. Patients with follow-up period of >1 year had the last platelet count of 174 ± 113 (n = 12). The most common complication was moderate/severe pain which occurred in 92% of patients without celiac block and in 20% of patients with celiac block. There was non-occlusive portal vein thrombus in 2 patients, pulmonary embolus in 1 patient, focal pancreatitis in 1 patient, and increased ascites and pleural effusion in 7 patients. Procedure-related 30–day mortality was 25% amongst patients with hematologic malignancies and 0% amongst patients with chemotherapy- or portal hypertension-induced splenomegaly. Partial splenic embolization is effective to correct thrombocytopenia in cancer patients and provides improved platelet count for long-term. It is a low risk procedure in patients with chemotherapy- or portal hypertension-induced splenomegaly, but has high mortality in hematologic malignancies. The postprocedural pain was significantly reduced by celiac plexus block. Based on our data the required amount of beads can be calculated to achieve target splenic infarct.

Long-term efficacy of partial splenic embolization for the treatment of steroid-resistant chronic immune thrombocytopenia.

Thrombopoietin-receptor agonists have been recently introduced for a second-line treatment of immune thrombocytopenia (ITP). Splenectomy has tended to be avoided because of its complications, but the response rate of splenectomy is 60-80% and it has still been considered for steroid-refractory ITP. We performed partial splenic embolization (PSE) as an alternative to splenectomy. Between 1988 and 2013, 91 patients with steroid-resistant ITP underwent PSE at our hospital, and we retrospectively analyzed the efficacy and long-term outcomes of PSE. The complete response rate (CR, platelets > 100 × 109/L) was 51% (n = 46), and the overall response rate (CR plus response (R), > 30 × 109/L) was 84% (n = 76). One year after PSE, 70% of patients remained CR and R. The group with peak platelet count after PSE ≥ 300 × 109/L (n = 29) exhibited a significantly higher platelet count than the group with platelet count < 300 × 109/L (n = 40) at any time point after PSE. The failure-free survival (FFS) rates at 1, 5, and 10years were 78, 56, and 52%, respectively. Second PSE was performed in 20 patients who relapsed (n = 14) or had no response to the initial PSE (n = 6), and the overall response was achieved in 63% patients. There were no PSE-related deaths. These results indicate that PSE is a safe and effective alternative therapy to splenectomy for patients with steroid-resistant ITP as it generates long-term, durable responses.

Eighty percent partial splenic embolization is a safe and effective procedure in management of cirrhotic hypersplenism

Background: Partial splenic embolization (PSE) has been proposed in patients with cirrhotic hypersplenism in cases when thrombocytopenia causes clinical manifestations or if there are contraindications to subsequent therapeutic procedures. We provide a retrospective review of the safety and favorable treatment results of 80% splenic embolization in patients with cirrhotic hypersplenism in our institute. Methods: Thirteen consecutive patients with cirrhotic hypersplenism were included in a 4-year study period. The indications for PSE were as follows: percutaneous treatment of hepatocellular carcinoma (HCC) (n = 3), transarterial chemoembolization plus hepatic arterial infusion chemotherapy for HCC (n = 2), preparation for major surgery (n = 5), and severe purpura (n = 3). PSE was performed with up to 80% reduction of splenic blood flow by radiological intervention. A tight protocol of prophylactic antibiotics was introduced. Patient demographics, procedure-related complication, and efficacy of PSE were analyzed. Results: The mean follow-up time was 26.1 ± 12.3 months. All the patients tolerated the procedure. The minor complication of postembolization syndromes such as fever and abdominal pain occurred in 38.5% and 61.5% of patients, respectively. Only a major complication of transient ascites needs diuretic therapy occurred in two patients. Pre-PSE platelet count was 35,077 ± 11,049/mm3, and it significantly increased 1 week after PSE, with a mean increase of platelet count to 384% of pre-PSE level (P Conclusion: Our series demonstrated that 80% PSE is a safe and effective method to treat patients with cirrhotic hypersplenism. It could not only increase the platelet count within a short period of time but also maintain it at an acceptable level for a long duration. Under a tight protocol of prophylactic antibiotic and delicate technique of PSE, there was no any septic complication developed in our series.

Safety and efficacy of partial splenic embolization in telaprevir-based triple therapy for chronic hepatitis C.

Pegylated-interferon/ribavirin (peg-IFN/RBV) therapy with a protease inhibitor is the standard therapy for genotype 1b chronic hepatitis C. Despite improving treatment outcomes, patients with thrombocytopenia are often difficult to treat because interferon commonly exacerbates thrombocytopenia. In this study, partial splenic embolization (PSE) was performed in patients with hypersplenism-induced thrombocytopenia to determine the effectiveness of this method as a potential treatment. Patients were pretreated with PSE and then received triple combination therapy. The safety and efficacy of PSE was evaluated. Eighteen patients were analyzed, including 12 patients with the interleukin 28B (IL28B) major genotype and 12 patients with the inosine triphosphatase (ITPA) major genotype. The median embolization rate with PSE was 70% (range: 40-85%). PSE increased the patients' platelet counts from 71.5×10(3) /μL (53-99×10(3) /μL) to 121.5×10(3) /μL (70-194×10(3) /μL; p=0.0002). The patients' platelet counts fluctuated above 50×10(3) /μL during the treatment. Specifically, the increase in the platelet count was significantly associated with the ITPA major genotype compared with the minor genotype (p=0.0057 at 2 weeks, p=0.0031 at 3 weeks, and p=0.0148 at 4 weeks). Adherence to peg-IFN-α2b was sufficient (1.38 μg/kg/week). The rapid viral response rate was 72.2% (13/18), the end of treatment response rate was 88.9% (16/18), and the sustained virological response (SVR) rate was 66.7% (12/18). The SVR rate for patients with the IL28B major genotype was 83.3% (10/12). No adverse effect due to PSE pretreatment was found in any patients. Furthermore, no patient discontinued treatment due to thrombocytopenia. PSE, in conjunction with triple combination therapy, is a useful and safe method to treat genotype 1b chronic hepatitis C patients with hypersplenism-induced thrombocytopenia.

Abstract No. 317 - Safety and efficacy of partial splenic embolization for hypersplenism: a meta-analysis

<h3>Purpose</h3> Partial splenic embolization (PSE) has been shown to be effective in treatment of thrombocytopenia due to hypersplenism in several small cohorts. However, PSE is infrequently performed, largely due to initial reports of high associated morbidity and mortality. Our study investigates the efficacy and complications associated with PSE using a meta-analysis. <h3>Materials and Methods</h3> Literature search was performed using Pubmed for articles published from 1980 to 2012. Studies with atleast 5 patients that used currently accepted methods of PSE with particulate and liquid embolics to achieve splenic infarction were included. Studies with embolization of the proximal splenic artery were excluded. Improvements in platelet count and complications were recorded. Meta-analysis was performed using random effects model due to heterogeneity between study groups. Comprehensive Meta-Analysis (CMA) V2 software was used to pool the results. <h3>Results</h3> 18 studies met inclusion criteria. Complications related to post-embolization syndrome occurred in most patients (abdominal pain rate=0.801,p=.003 and Fever=0.830, p=.001) but were easily managed with pain medications/antipyretics. Major complications are reported in the Table. Results fall within acceptable complications thresholds set by Society of Interventional Radiology (SIR) for splenic embolization. 6 studies reported platelet counts. Meta-analysis showed a mean platelet improvement of 114.832 +/- 24.325, p <.001. <h3>Conclusion</h3> PSE is effective in improving thrombocytopenia due to hypersplenism with a statistically significant mean improvement of platelet counts. PSE is a safe procedure with a complication rate that falls within thresholds set forth by SIR. Table 1

Partial Splenic Embolization Facilitates the Adherence to Peginterferon in Chronic Hepatitis C with Thrombocytopenia

Platelet counts before starting the treatment affect the discontinuation and dose reduction of peginterferon in chronic hepatitis C. Thrombocytopenia leads to failure to achieve sustained virological response. This study was undertaken to evaluate the efficacy of partial splenic embolization (PSE) prior to starting peginterferon therapy combined with ribavirin in chronic hepatitis C patients showing thrombocytopenia. We compared the clinical features of 11 patients receiving PSE (PSE group) prior to starting the combined therapy with those of 13 patients not receiving PSE (non-PSE group). All of the patients showed platelet counts ≤12×10(4)/mm(3) and serum hepatitis C virus-RNA levels ≥100 KIU/mL at baseline. The end-point of PSE was a volume of splenic infarction over 75%. Peginterferon alpha-2b at a dose of 1.2 µg/kg was administered by subcutaneous injection once a week. The dose of ribavirin was weight adjusted. PSE was successfully performed without serious adverse events. The period from PSE to starting the combined therapy was 14 (6-27) days. After PSE, platelet counts were significantly increased. In PSE group, platelet counts during the combined therapy were maintained above those at baseline. In non-PSE group, platelet counts at the 2nd week after the start of the combined therapy significantly decreased to less than those at baseline. Overall, 80% adherence to expected peginterferon dose was not achieved in 5 patients (45%) of PSE group and in 11 (85%) of non-PSE group (p=0.043). Increased platelet counts after PSE facilitates the adherence to peginterferon therapy in chronic hepatitis C patients with thrombocytopenia.

Long-term efficacy of partial splenic embolization for hypersplenism in cirrhosis

目的 评价部分性脾栓塞术(partial splenic embolization,PSE)治疗肝硬化脾功能亢进的远期疗效.方法对1998年5月以前采用PSE治疗的62例肝硬化脾功能亢进患者进行长期随访,随访指标主要为外周血白细胞、血小板和红细胞计数.选取术后1～5年资料完整的38例进行分析,其中栓塞程度≥60%者23例,50%～59%者9例,＜50%者6例.结果白细胞和血小板计数分别于术后第3天和2周达到峰值,然后二者逐渐下降,但对不同的栓塞程度其下降趋势差异具有显著性意义(P=0.001).栓塞程度≥60%者,术后白细胞和血小板计数均较术前显著升高并一直维持到术后第5年(P＜0.001),且第5年时白细胞计数仍为正常,第4年时血小板计数仍达正常.栓塞程度50%～59%者,术后白细胞和血小板计数也较术前明显升高并可达到术后第5年和第4年(P＜0.05)水平,但它们分别在术后第2年和第1年就降至正常范围以下.而对于栓塞程度＜50%者,术后1个月白细胞和血小板计数都降至正常范围以下.红细胞计数在术后一直无明显变化(P＞0.05).随着栓塞程度的增加,术后反应加重,并发症也随之增加.结论栓塞程度控制在60%～70%可有效治疗肝硬化脾功能亢进,分次栓塞可减轻术后反应、减少并发症。

Long-term efficacy of partial splenic embolization in children

Purpose: To elucidate the role of partial splenic embolization (PSE) procedures, long-term outcome was assessed in terms of the recurrence of thrombocytopenia. Methods: A retrospective study was performed after 41 PSE procedures in 36 patients for hypersplenism owing to portal hypertension. The underlying disease was biliary atresia in 32 patients, extrahepatic portal obstruction in 3, and idiopathic cirrhosis in 1. Results: The average volume embolized was 70.1%. The patients were followed up from 20 days to 182 months (average, 70.8 months). Five patients subsequently died, and 6 underwent liver transplantation. The causes of death or the reasons for liver transplantation were not related to hypersplenism. Eleven patients (30.6%) had recurrence of thrombocytopenia (<100,000/mm 3). There was no significant difference in the volume embolized or platelet count before PSE between the patients with and without recurrence of thrombocytopenia. The peak value of platelet count after PSE was significantly lower in the patients with recurrence of thrombocytopenia ( P = .0091). In 17 of 24 survivors without liver transplantation, platelet counts remained normal throughout the follow-up period. Conclusions: PSE is a safe and effective procedure. Hematologic indices improved in all 36 patients after PSE, and its long-term efficacy was shown in 70% of the survivors.

Long-term Efficacy of Partial Splenic Embolization in Children

Long-term Efficacy of Partial Splenic Embolization in Children