Gel foam or microsphere particles for partial splenic artery embolization in managing patients with hypersplenism

Abstract

Background and aim of study: Spleen is the largest lymphoid organ on the human body, it has a very important immunological functions. Portal hypertension accompanied liver cirrhosis commonly leads to splenomegaly which may be complicated by hypersplenism. Also liver cirrhosis is frequently associated with decreased hematological indices with subsequent anemia, thrombocytopenia and leucopenia. Spontaneous bleeding can delay any surgical or endovascular intervention. Leucopenia with decreased immunity may interfere with treatment of cancer patients using chemotherapy. The objective of this prospective study is to achieve the maximum splenic tissue infarction with the least possible complications by performing partial splenic artery embolization in cases of hypersplenism through comparing two materials; gel foam in one group and microspheres in another group. Patients and methods: The study was conducted from October 2014 to September 2015. Thirty patients included in this study were presented by hypersplenism. They were 14 males and 16 females with mean age of 51 years. All patients were subjected to full history taking, clinical examination, laboratory investigations, pelvi-abdominal US and interventional procedure (transcatheter partial splenic artery embolization). The patients were divided into two groups, group (1): Fifteen patients were subjected to partial splenic embolization (PSE) using gel foam, group (2): Fifteen patients were subjected to partial splenic embolization (PSE) using microspheres. Results: Multiple complications appeared after the procedure some of them were of minor importance as post embolization syndrome (fever, pain and nausea) that continued for two days and disappeared in five patients. Haematemesis occurred in one patient of the first group. One case in the first group showed abscess formation after the procedure and this patient underwent the procedure using gel foam particles, four cases showed portal vein thrombosis, two in each group, Pleural effusion appeared in two patients of first group. Regarding the efficacy of the procedure, improvement in laboratory tests were nearly the same in both groups. However, regarding the occurrence of serious complications, the microsphere particles group show fewer complications than gel foam group. Conclusion: PSE using gel foam or microsphere showed nearly the same efficacy with no significant difference between the improvement in laboratory tests. However, using microsphere particles was associated with fewer occurrences of serious complications when compared with using gel foam. Keywords: Splenomegaly, Hypersplenism, PSE, Thrombocytopenia