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Role of Partial Splenic Artery Embolization (PSE) in the Treatment of Hypersplenism

Background: Hypersplenism mainly manifest by thrombocytopenia with or without obvious bleeding tendency that become an obstacle to undergo any surgical intervention or receive some therapeutic regime. This dilemma can be solved using the evolving partial splenic artery embolization (PSE) techniques. Aim of Study: The primary aim is to evaluate the role and efficacy of PSE in the treatment of hypersplenism. Patients and Methods: In the period between March 2016 and August 2018, this prospective case series study was conducted and included 26 patients (11 males and 15 females) with their age ranging from 14 to 72 years old. All patients suffered from hypersplenism secondary to liver cirrhosis and had thrombocytopenia ranging from 20,000/ μL to 83,000/μL, with 17 of them had associated leucopenia ranging from 1,250/μL to 3,420/μL. 20 patients had hypercellular and 6 patients had normocellular bone marrow. They all underwent one session of PSE by the usage of two sizes of either PVA or Microspheres with the extent of planned embolization volume was set between 30%-70% of initial spleen size. Results: Up to 1 year follow-up, the platelet counts rose significantly with patients reached their normal values in 1 st , 3rd, 6th months and 1 st year follow-ups were 80.8%, 71.4%, 91.7% and 83.3% respectively. In all 17 patients who had associated leucopenia, their leucocytic counts rose significantly with patients reached their normal values in 1 st , 3 rd , 6 th months and 1 st year follow-ups were 88.2%, 87.5%, 83.3% and 75% respectively. No significant improvement regarding the RBC counts in all patients. Among the 24 patients who had clinical manifestations; 22 (91.7%) of them showed clinical improvement and 2 (8.3%) patients showed less improvement. Conclusion: PSE with careful care is an effective nonsurgical minimally invasive procedure in avoiding the potential post-procedure complications and achieving remarkable hematologic response on controlling hypersplenism. Correspondence to: Dr. Ahmed M. Amir, The Department of Intervention Radiology, Nasser Institute for Research and Treatment, Cairo, Egypt