Splenic Artery Steal Syndrome Research Articles

Relationship Between Perioperative Factors and Splenic Artery Steal Syndrome After Orthotopic Liver Transplant: A Retrospective Clinical Study.

After orthotopic liver transplant, ischemia of biliary tract and graft loss may occur due to impaired hepatic arterial blood flow. This situation with hypersplenism and impaired hepatic arterial blood flowis defined as splenic artery steal syndrome.The aim of this study was to investigate the relationship between perioperative factors and splenic artery steal syndrome in orthotopic liver transplant patients. Forty-five patients who underwent orthotopic liver transplant between 2014 and 2022 were included in the study. The data for the patients were obtained from the hospital database, including the intraoperative anesthesiology and postoperative intensive care records. Eleven patients were diagnosed with splenic artery steal syndrome. Patients with splenic artery steal syndrome had higher need for intraoperative vasopressor agents (P = .016) and exhibited lower intraoperative urine output (P = .031). In the postoperative intensive care follow-up, patients with splenic artery steal syndrome had higher levels of C-reactive protein during the first 48 hours (P = .030). Intraoperative administration of vasopressor drugs, low urine output, and early postoperative high C-reactive protein levels were associated with the development of splenic artery steal syndrome in patients undergoing orthotopic liver transplant. Future studies should focus on investigation of biomarkers associated systemic hypoperfusion that may contribute to the development of splenic artery steal syndrome.

Splenic Artery Steal Syndrome in Patients with Liver Cirrhosis: A Retrospective Clinical Study.

BACKGROUND Splenic artery steal syndrome (SASS) can aggravate liver damage in patients with cirrhosis. This study explored whether SASS could be an effective therapeutic target for improving hepatic artery perfusion and liver function in patients with decompensated cirrhosis. MATERIAL AND METHODS Based on inclusion and exclusion criteria, 87 patients with hepatitis B cirrhosis and portal hypertension hypersplenism admitted to our General Surgery Department for splenectomy and pericardial devascularization surgery were selected. A total of 35 cases met the diagnostic criteria of SASS and were assigned to the SASS group; the remaining 52 cases were assigned to the control group. The indicators before, during, and after surgery were compared between the 2 groups. RESULTS There were no significant differences in preoperative and intraoperative indicators between SASS group and control group (P>0.05). The MELD score 7 days after surgery and the hepatic artery diameter and hepatic artery velocity 14 days after surgery in both groups were significantly better than before surgery. The MELD score 7 days after surgery in the SASS group was significantly better than that in the control group, and the hepatic artery diameter and hepatic artery velocity 14 days after surgery in the SASS group were significantly better than those in the control group (P<0.05). CONCLUSIONS Splenectomy and pericardial devascularization surgery was an effective treatment to redirect blood flow to the hepatic artery for cirrhotic patients diagnosed with SASS. The introduction of cirrhotic SASS into clinical practice may benefit more patients with cirrhotic portal hypertension and hypersplenism.

Role of Interventional Radiology in the Management of Early Vascular Complications After Liver Transplant.

A hepatic vascular complication after liver transplant is a critical situation, often resulting in graft failure and potentially leading to patient death. Early diagnosis and treatment of vascular complications can provide prolonged graft survival and prohibit further complications. This study presents our experiences with endovascular treatment during the first week after liver transplant. Between January 2012 and February 2021, 240 liver transplants were performed, with 43 patients having early endovascular treatment (37 men; mean age 27 ± 2.9 years) at a single center. Early endovascular interventions were carried out 1 to 7 days (mean ± SD of 2.7 ± 0.24 days) after transplant. Patients with vascular complications were grouped by arterial, venous, and portal complications. In addition, arterial complications were subgrouped by occlusive (hepatic artery thrombosis) and nonocclusive (hepatic artery stenosis/splenic artery steal syndrome) complications. Patients had median follow-up of 47 ± 4 months. In the first week after liver transplant, vascular complications included splenic artery steal syndrome in 27 patients (62.7%), hepatic complications in 10 patients (23.2%) (7 with hepatic artery thrombosis, 3 with hepatic artery stenosis), hepatic venous outflow complications in 4 patients (9.3%), and portal vein complications in 2 patients (4.6%). Only 1 patient required revision surgery because of excessive arterial kinking; the remaining patients with arterial complications were successfully managed with multiple endovascular treatment attempts. Patients with splenic artery steal syndrome were treated by selective arterial embolization with coil devices. Resistivity index, peak systolic velocity of hepatic arteries, and portal vein maximal velocity significantly improved (P < .001). Patients with hepatic venous outflow and portal vein complications who had endovascular treatments and vascular structures maintained good results over follow-up. Early endovascular intervention is feasible and safe for hepatic vascular complications following liver transplant, with high success treatment rates with advances in interventional radiology.

Successful management of splenic artery steal syndrome after living donor liver transplantation by splenic artery embolization

Successful management of splenic artery steal syndrome after living donor liver transplantation by splenic artery embolization

Interventional Radiology Management of Adult Liver Transplant Complications.

Liver transplant remains the definitive therapy for patients with end-stage liver disease. Outcomes have continued to improve, in part owing to interventions used to treat posttransplant complications involving the hepatic arteries, portal vein, hepatic veins or inferior vena cava (IVC), and biliary system. Significant hepatic artery stenosis can be treated with angioplasty or stent placement to prevent thrombosis and biliary ischemic complications. Hepatic arterioportal fistula and hepatic artery pseudoaneurysm are rare complications that can often be treated with endovascular means. Treatment of hepatic artery thrombosis can have mixed results. Portal vein stenosis can be treated with venoplasty or more commonly stent placement. The rarer portal vein thrombosis can also be treated with endovascular techniques. Hepatic venous outflow stenosis of the hepatic veins or IVC is amenable to venoplasty or stent placement. Complications of the bile ducts are the most encountered complication after liver transplant. When not amenable to endoscopic intervention, biliary stricture, bile leak, and ischemic cholangiopathy can be treated with percutaneous transhepatic cholangiography with biliary drainage and other interventions. New techniques have further improved care for these patients. Transsplenic portal vein recanalization has improved transplant candidacy for patients with chronic portal vein thrombosis. Spontaneous splenorenal shunt and splenic artery steal syndrome (nonocclusive hepatic artery hypoperfusion syndrome) remain complicated topics, and the role of endovascular embolization is developing. When patients have recurrence of cirrhosis after transplant, most commonly due to viral hepatitis, transjugular intrahepatic portosystemic shunt (TIPS) may be required to treat symptoms of portal hypertension. Online supplemental material is available for this article. ©RSNA, 2022.

Early diagnosis and treatment of splenic artery steal syndrome after liver transplantation

Objective: to study the incidence of splenic artery steal syndrome (SASS) in our own series of liver transplant surgeries and to determine diagnostic and therapeutic tactics. Materials and Methods. During the 3.5 years of existence of the liver transplant program in the Republic of Tatarstan, 77 cadaveric liver transplantations (LTx) have been performed. Postoperative SASS occurred in 4 cases (5.2%). Among the patients were 3 women and 1 man; mean age was 38 years. Doppler ultrasonography of the liver vessels and celiacography were used for diagnosis. Proximal splenic embolization was used as a way to correct the syndrome. Results. In all clinical cases, SASS was timely diagnosed and corrected by endovascular image-guided intervention. The patients were discharged with good hepatic graft function. The complication did not affect the length of hospital stay. Conclusion. SASS remains a severe vascular complication of LTx, which can lead to graft dysfunction and possible loss. Timely detection and treatment prevent severe consequences for the liver recipient.

Splenic artery steal syndrome in patients with orthotopic liver transplant: Where to embolize the splenic artery?

This study compared proximal and distal embolization of the splenic artery (SA) in patients with splenic artery steal syndrome (SAS) after orthotopic liver transplantation (OLT) regarding post interventional changes of liver function to identify an ideal location of embolization. 85 patients with SAS after OLT treated with embolization of the SA between 2007 and 2017 were retrospectively reviewed. Periinterventional DSA was used to assess treatment success and to stratify patients according to the site of embolization. Liver function was assessed using following laboratory values: bilirubin, albumin, gamma-glutamyl transferase, glutamat-pyruvat-transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), Alkaline Phosphatase (ALP), aPTT, prothrombin time and thrombocyte count. Descriptive statistics were used to summarize the data. Median laboratory values of pre, 1- and 3-days, as well as 1-week and 1-month post-embolization were compared between the respective embolization sites using linear mixed model regression analysis. All procedures were technically successful and showed an improved blood flow in the hepatic artery post-embolization. Ten Patients were excluded due to re -intervention or inconsistent image documentation. Pairwise comparison using linear mixed model regression analysis showed a significant difference between proximal and distal embolization for GPT (57.0 (IQR 107.5) vs. 118.0 (IQR 254.0) U/l, p = 0.002) and GOT (48.0 (IQR 48.0) vs. 81.0 (IQR 115.0) U/l, p = 0.008) 3-days after embolization as well as median thrombocyte counts 7-days after embolization (122 (IQR 108) vs. 83 (IQR 74) in thousands, p = 0.014). For all other laboratory values, no statistically significant difference could be shown with respect to the embolization site. We conclude that long-term outcomes after embolization of the SA in the scenario of SAS after OLT are irrespective of the site of embolization of the SA, whereas a proximal embolization potentially facilitates earlier normalization of liver function. Choice of technique should therefore be informed by anatomical conditions, safety considerations and preferences of the interventionalist.

Multimodality Imaging after Liver Transplant: Top 10 Important Complications.

Patients who have undergone liver transplant are now regularly seen in day-to-day radiology practice. All surgical techniques for liver transplant require arterial, portal venous, hepatic venous and caval, and biliary anastomoses. This review is focused on the 10 "not to be missed" complications of liver transplant that affect the health and life of the graft and graft recipient. Arterial complications are the most common and devastating. Early hepatic artery thrombosis may be catastrophic because the biliary tree is solely dependent on the hepatic artery after transplant and collateral vessels have not yet formed. In contrast, delayed hepatic artery thrombosis may be more insidious as collateral arteries develop. US findings of delayed hepatic artery thrombosis may be similar to those of hepatic artery stenosis and celiac artery stenosis. Splenic artery steal syndrome is an increasingly recognized cause of graft ischemia. Venous complications are much less common. Hepatic venous and caval complications are notable for their increased incidence in living-donor and pediatric transplants. Biliary complications often result from arterial ischemia. Biliary cast syndrome is a notable example in which ischemic biliary mucosa sloughs into and obstructs the duct lumens. Neoplasms also may occur within the hepatic graft and may be due to recurrent malignancy, posttransplant lymphoproliferative disorder, or metastases. US is the initial imaging modality of choice, particularly in the acute postoperative setting. Further evaluation with contrast-enhanced US, CT, or MRI; catheter angiography; endoscopic retrograde cholangiopancreatography; and/or nuclear medicine studies is performed as needed. An invited commentary by Bhargava is available online. Online supplemental material is available for this article. ©RSNA, 2022.

Diagnosis and treatment of splenic artery steal syndrome after liver transplantation

AbstractIntroductionSplenic artery steal syndrome is a phenomenon which cause graft ischaemia and dysfunction after liver transplantation.Case PresentationA 31 year old women underwent living donor liver transplantation (LDLT) with a diagnosis of cryptogenic liver cirrhosis. In postoperative follow‐up liver enzymes were elevated. Dynamic computed tomography and digital subtraction angiography revealed splenic artery steal syndrome. Splenic artery ligation was performed for treatment.DiscussionThe diagnosis of splenic artery steal syndrome is made by the presence of slowed hepatic artery flow compared to the splenic artery without hepatic artery thrombosis or stenosis on digital subtraction angiography.ConclusionAlthough interventional radiological procedures are the first‐line treatment method, surgical treatment methods (splenectomy, splenic artery ligation) are successful in increasing hepatic artery flow.

New possibilities for testing direct arterial liver perfusion after liver transplantation

The aim of the study was to show new promising possibilities of direct perfusion test for the transplanted liver.Materials and methods. We have performed 246 liver transplantations (1998–2020). Since 2015 arterial complications were detected in 24 (23%) patients after 105 transplantations complicated by liver hypoperfusion: splenic artery steal syndrome (n = 8), hepatic artery thrombosis (n = 7), combination of hepatic artery stenosis and steal syndrome (n = 6), hepatic artery stenosis (n = 3). Endovascular interventions were performed in these cases for revascularization. Direct perfusion test was performed in 8 patients.Results. The liver perfusion index increased from 0.27 (0.13–0.45) to 0.62 (0.33–0.89) after endovascular procedures. Sufficient perfusion was ≥0.65.Conclusion. Direct liver perfusion test makes possible to identify and objectify graft blood supply, timely and adequate correction, and reduces the risk of developing biliary ischemic complications.

Splenic Tumor in a Patient After Liver Transplantation

Question: A 38-year-old man who underwent a liver transplant due to primary sclerosing cholangitis 9 years ago and a colectomy for descending colon cancer and ulcerative colitis 3 years ago was admitted for a regular checkup. Of note, his liver transplant procedure was complicated by splenic artery steal syndrome immediately after surgery, for which an early relaparotomy with splenic artery ligation was performed with normalization of flow in the hepatic artery and liver function tests. His immunosuppressive regimen consisted of tacrolimus and azathioprine once daily.

Time is of the essence: A single-center experience of hepatic arterial supply impairment management in pediatric liver transplant recipients.

Impairment of hepatic arterial flow including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), and splenic artery steal syndrome (SASS) is potentially life-threatening complications. The proposed early diagnosis and urgent treatment strategy of graft arterial flow reduction aim to decrease morbidity and mortality. Pediatric patients with known hepatic arterial flow impairment were retrospectively reviewed. Patients were grouped by occlusive (HAT) and non-occlusive (HAS/SASS) arterial flow reduction. Patients with HAT were further divided in two groups based on the estimated maximal hepatic artery occlusion time ≤8 and >8hours. Impairment of hepatic arterial flow developed in 32 of 416 pediatric liver transplant recipients. HAT, HAS, and SASS incidences were 4.1% (n=17), 2.2% (n=9), and 1.4% (n=6), respectively. Neither graft loss nor death occurred in the non-occlusive group. The probabilities of sepsis (OR, 1.7; 95% CI, 1.14-2.53; P=.008) and graft loss or death (OR, 1.42; 95% CI, 1.04-1.92; P=.046) were higher in the occlusive group. Patients with estimated maximal duration of hepatic artery occlusion≤8hours (n=7; 41.2%) did not have ischemic-type biliary lesions and sepsis (P=.044 and 0.010, respectively) but had excellent 3-year graft survival compared with>8hours group (100% vs 40%; P=.037). Multivariate analysis revealed HAT manifestation by fever was associated with increased chances of graft loss or death. Occlusive arterial complications impose higher risks of graft loss and death. Thorough arterial supply monitoring by Doppler ultrasonography and urgent endovascular arterial flow restoration may salvage both graft and the recipient.

S2577 Management of Splenic Artery Steal Syndrome Following Liver Transplantation by Splenic Artery Embolization

INTRODUCTION: The following case series analyzes patients that received a splenic artery embolization (SAE) following an orthotopic liver transplant (OLT). SAE following OLT is performed to correct splenic artery steal syndrome (SASS), where the splenic artery experiences an increase in blood flow at the expense of the hepatic artery. Normal hepatic artery blood flow is needed to ensure a successful transplant. CASE DESCRIPTION/METHODS: Four patients presented for OLT; three with living donors and one standard donor. The indications for OLT were alcoholic cirrhosis, cryptogenic cirrhosis with pancytopenia, NASH, and primary sclerosing cholangitis. The average MELD scores were 18 [11-26]. Two patients had previous history of CT diagnosed thrombosis in the right hepatic and portal veins. One patient had an intraoperative portal vein thrombectomy. Three patients had good size matched anastomotic connections for the hepatic arteries, while one patient’s recipient arteries were smaller than the donors. Upon post-transplant ultrasound, each patient had an increased hepatic artery resistivity index (RI) in the proximal, middle and distal parts of the artery. This indicates decreased blood flow to the liver as part of SASS. The relevant laboratory values immediately preceding SAE showed an average AST of 171.5 [45-301], ALT of 378.25 [249-458], alkaline phosphate of 176.75 [46-368], total bilirubin of 3.9 [1.9-6.6], direct bilirubin of 2.6 [1.4-4.4], and creatinine of 0.9 [0.73-1.05]. To correct this, all patients received an SAE on average 96.5 hours [20-213] following OLT to re-establish adequate blood flow to the liver. This is confirmed through a follow up ultrasound, which reveals decreased hepatic artery RI in all patients. The patient with primary sclerosing cholangitis received a re-do hepatojujenoctomy, however the other three patients did not have any strictures based on MRCP. None of the patients had graft rejection and are currently 6 months to 1 year post-transplant. DISCUSSION: SAE following OLT serves as a viable option for treating SASS. This procedure re-stored proper blood flow through the hepatic artery to the transplanted liver, which prevents graft rejection.

Splenic Artery Embolization for Nonocclusive Hepatic Artery Hypoperfusion

AbstractVarious minimally invasive, surgical, and laparoscopic interventions are performed for treatment and management of splenic artery steal syndrome in liver transplant and cirrhotic patients. Common approaches include splenic artery banding, ligation, stenting, and embolization to increase hepatic arterial flow. Splenic artery embolization has undergone further development to facilitate timely diagnosis, increase efficacy, decrease adverse outcomes, and improve patient selection. We review the current diagnostic modalities and technical advancements of splenic artery embolization to improve hepatic arterial perfusion in patients with splenic artery steal syndrome.

3:27 PM Abstract No. 159 Endovascular treatment of splenic artery steal in pediatric liver transplant patients

Literature regarding splenic artery embolization for splenic artery steal syndrome (SASS) in the pediatric liver transplant population is limited, possibly due to lack of recognition of this entity. The purpose of this study is to evaluate the safety and efficacy of splenic artery embolization in pediatric liver transplant patients with clinical and imaging findings concerning for SASS. A retrospective review was performed on all pediatric liver transplant patients who had undergone splenic artery embolization for suspected SASS at a tertiary pediatric institution between June 2013 and May 2018. Parameters assessed included patient age, time from transplant to splenic artery embolization, transplant type, pre-and-post procedure Doppler ultrasound (DUS) findings, procedural details, complication rate, pre-and-postprocedural laboratory parameters, and clinical efficacy. 5 patients (average age, 8 years; median, 10 years; range, 2-17 years) had proximal to mid splenic artery embolization for suspected SASS. Technical success = 100%. Average time from transplant to embolization was 61.6 days (median = 3 days; range, 2-265). All patients had parvus tardus waveform on pre-embolization DUS. Average pre and post embolization peak hepatic artery systolic velocity = 35.7 cm/s (median, 24 cm/s; range, 15.7-89) and 39.1 cm/s (median, 32 cm/s; range, 26-55), respectively. Average pre and post embolization resistive indices = 0.71 (median, 0.73; range, 0.4-1) and 0.62 (median, 0.6; range, 0.5-0.8), respectively. Average pre and post embolization total bilirubin levels = 1.5 mg/dL (median, 1.3; range, 0.4-3.7) and 1.02 mg/dL (median, 0.9; range, 0.3-2.4), respectively. Average pre and post embolization platelet levels = 72.6 thousand/microL (median, 43; range, 18-181) and 141 thousand/microL (median, 111; range, 49-183). There were no major complications. All patients had morphologically improved hepatic artery upstroke on DUS following splenic artery embolization. Splenic artery embolization for suspected SASS in pediatric liver transplant patients is potentially a safe and effective technique in improving graft function and improving thrombocytopenia.

Successful Management of Splenic Artery Steal Syndrome after Living Donor Liver Transplantation

Successful Management of Splenic Artery Steal Syndrome after Living Donor Liver Transplantation

04:12 PM Abstract No. 256 Splenic embolization for splenic arterial steal syndrome

Splenic arterial steal syndrome (SASS) is preferential splenic arterial flow with hepatic arterial hypo-perfusion seen on angiography without hepatic arterial anatomical abnormality. The study compares liver Doppler findings before and after splenic embolization 104 patients were treated with splenic arterial embolization (SAE) for various indications in the past seven years at our institution. After IRB approval, we identified patients with SASS as indication for SAE. Paired t-test was performed to compare the available pre and post-embolization hepatic artery peak systolic velocities (PSV), resistive indices (RI) and main portal vein velocities. 11 patients underwent proximal SAE (between the dorsal pancreatic artery and hilum with coils/plugs) for SASS. Liver Doppler findings were compared before and after SAE done to increase liver transplant hepatic arterial flow in 8/11 patients. Main portal vein velocity significantly decreased post SAE [mean 53.1 cm/s (14-98 cm/s) to 31.3 cm/s (14-54 cm/s), p<0.05]. Hepatic artery RI decreased post SAE [mean 0.74 (0.46-0.99) to 0.63 (0.34-0.88), p<0.05]. No significant difference between hepatic artery PSV (p=0.5) was observed after SAE [pre 153.5 cm/s (45-340 cm/s) to post 113.9 cm/s (48-171 cm/s)]. No splenic infarctions or abscesses were identified. Total bilirubin remained stable immediately post procedure (mean 14.4 to 13.9, p=0.4), but decreased one month post-embolization (mean 10.9 to 3.7, p=0.1). Pre-embolization albumin values remained stable immediate and 1 month post procedure. SAE is safe and effective procedure to increase hepatic arterial flow to the transplant liver with SASS. Following SAE for SASS, hepatic artery RI and main portal vein velocity are responsive to the procedure and the liver Doppler may serve as a tool to predict procedural success. Both the decrease in portal venous velocity and hepatic artery RI may support the hepatic arterial buffer response (HABR) theory as a cause or contributor to the SASS

A retrospective study on the different methods of interventional therapy for splenic artery steal syndrome after liver transplantation

Objective To study the use of contrast-enhanced ultrasound in diagnosing splenic arterial steal syndrome (SASS) after liver transplantation, and to compare the curative effect, safety and follow-up results of the different embolization methods in the treatment of SASS after liver transplantation. Methods From January 2005 to December 2017, 41 patients after liver transplantation in our hospital developed splenic artery steal syndrome and were treated with splenic arterial embolization. All these patients underwent ultrasound, and in 19 patients contrast-enhanced ultrasonography was also done to detect the presence of splenic artery steal. The findings were confirmed by angiography. These patients then underwent splenic arterial embolization. In 32 patients coil embolization was done (group A) and in 9 patients embolization was assisted with Amplatzer occluders (group B). Results In all the 41 patients with SASS, angiography after splenic artery embolization showed the second and third order arterial branches in the liver increased in number and in diameter with good blood flow compared with those before treatment. The postoperative blood flow and pattern on ultrasound returned to normal. In group A, 12 patients (12/32, 37.5%) developed splenic infarction, including 11 patients with partial splenic infarction, and 1 patient developed a splenic abscess after complete splenic infarction. In group B, two patients developed partial splenic infarction (2/9, 22.2%). All the patients with splenic infarct had no clinical symptoms. No treatment was required except for the patient who developed splenic abscess after complete splenic infarction. The patient recovered well after treatment with antibiotics and splenic abscess drainage. There was no other complications. Conclusions Contrast-enhanced ultrasound provided early diagnosis of splenic artery steal after liver transplantation. Interventional splenic artery embolization was safe and effective to treat splenic arterial steal syndrome after liver transplantation. Coil embolization assisted with Amplatzer occluders was better than the traditional coil embolization with more accurate embolization site and fewer complications. Key words: Liver transplantation; Splenic artery steal syndrome; Contrast-enhanced ultrasound; Interventional treatment; Splenic arterial embolization

The possibilities of interventional radiology before and after orthotopic liver transplantation

Presented the case of a combined approach preparation of 47 years old patient with primary biliary cirrhosis for orthotopic liver transplantation (OLT) and arterial flow insufficiency correction after surgery. The patient was under waiting list for OLT due liver cirrhosis progression. The patient underwent Intraportal infusion of autologous bone marrow mononuclear cells (MNC) which is allowed temporary stabilized the cirrhotic transformation. The transjugular intrahepatic portosystemic shunt (TIPS) procedure performed due to portal hypertension progression with episodes of bleeding from the esophageal and gastric varices, that allowed to receive organ donor and OLT. At 6 months after OLT the patient had clinical signs of a jaundice caused by splenic artery steal syndrome which was corrected by endovascular intervention: splenic artery trunk embolization.

Splenectomy plus periesophagogastric devascularization in the treatment of cirrhotic patients with portal hypertention and splentic artery steal syndrome

Objective To study the hemodynamic changes before and after splenectomy plus periesophagogastric devascularization in patients with splenic artery steal syndrome (SASS) so as to provide a theoretical basis for the treatment of portal hypertension concomitant with hypersplenism. Methods The database of 30 patients who underwent splenectomy plus devascularization from January 2015 to January 2017 was studied retrospectively. Color Doppler ultrasound was performed to detect hemodynamic changes in the hepatic artery, splenic artery, splenic vein and portal vein in patients with portal hypertension and in healthy controls. The outcomes between preoperative and postoperative biochemical indicators were compared. Results The hemodynamic indexes of splenic artery, splenic vein and portal vein in the study group were significantly higher than those in the control group (P<0.05). The peak systolic velocity [(35.3±5.1) cm/s vs. (53.1±7.0) cm/s] and blood flow [(175.9±30.5) ml/min vs. (297.0±48.3) ml/min)] of the hepatic artery were significantly lower than those of the control group (P<0.05). The peak systolic velocity [(60.7±11.9) cm/s vs. (35.3±5.1) cm/s] and blood flow [(388.8±79.6) ml/min vs. (175.86±30.46) ml/min] of the hepatic artery increased significantly after operation (P<0.05). After splenectomy, the levels of the leucocyte [(7.9±3.8)×109/L vs. (2.8±1.4)×109/L)], thrombocyte [(491.3±194.9)×109/L vs. (47.4±16.0)×109/L)], bilirubin [(15.0±10.6) μmol/L vs. (24.4±13.8) μmol/L)] and transaminase [(32.94±8.57) U/L vs. (43.37±16.59) U/L)] reco-vered when compared with the preoperative data (P<0.05). Conclusions SASS was detected in cirrhotic patients who had portal hypertension concomitant with hypersplenism. Splenectomy plus periesophagogastric devascularization were effective and safe for cirrhotic patients with hypersplenism and concomitant esophageal and gastric variceal bleeding. Key words: Cirrhosis; Portal hypertension; Hypersplenism; Hemodynamics; Devascula-rization