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SPLENIC ARTERY EMBOLIZATION IN OUR OWN MODIFICATION IN PATIENTS WITH SEGMENTAL PORTAL HYPERTENSION AND BLEEDING FROM VARICES OF THE GASTRIC FUNDUS

There is still no single point of view regarding the choice of the most effective method for treating left-sided portal hypertension, due to the difficulties in organizing the recruitment of patient groups for controlled studies on this topic. Aim. Preliminary analysis of the results of performing endovascular embolization of the splenic artery in our own modification in patients with left-sided portal hypertension. Materials and methods. Endovascular embolization of the splenic artery in our own modification was performed in three patients with chronic recurrent pancreatitis and left-sided portal hypertension (all males) aged 46 to 59 years after a repeated episode of bleeding from varices of the gastric fundus (2 to 3 relapses). A distinctive feature of our modification of X-ray endovascular partial embolization of the proximal segment of the splenic artery was that the criterion for stopping the process of reducing blood flow through the splenic artery was endoscopic confirmation of the fact of achieving reliable hemostasis. Results and discussion. All patients underwent successful surgery. Two patients were transferred after surgery to the Department of Surgical Pancreatology, Hepatology and Transplantation. In one case, it was required to stay in the intensive care unit for four days after surgery due to the severity of preoperative blood loss. The time spent in hospital in the postoperative period was (Me [min; max]) - 7 [6; 7] days. During the postoperative observation of these patients for the period from 22 to 60 months, no recurrence of bleeding from gastric varices was noted. In all patients, endoscopic examination after a year showed regression of the degree of expansion of gastric varices. Сonclusions. The method of endovascular embolization of the splenic artery presented in the article makes it possible to effectively achieve reliable hemostasis in bleeding from varices of the fundus of the stomach in patients with left-sided portal hypertension while maintaining blood flow through the splenic artery sufficient to minimize the risk of developing total necrosis and abscess of the spleen, necrotic changes in the fundus of the stomach and pancreas The reproducibility of the surgical intervention, its effectiveness and safety should be noted. It is advisable carry out further studies of the effectiveness of the technique in randomized controlled trials.