Safety and efficacy of splenic artery embolization for the treatment of gastric variceal bleeding secondary to left-sided portal hypertension

Abstract

Background : : Left-sided portal hypertension (LPH) is an uncommon clinical condition resulting from splenic vein stenosis/occlusion, which may cause bleeding from gastric varices. This study reviewed the long-term safety and efficacy of splenic artery embolization for the treatment of gastric varix bleeding secondary to splenic vein thrombosis. Methods : : From April 2008 to March 2020, all consecutive patients diagnosed with LPH-associated variceal bleeding who had undergone percutaneous splenic artery embolization were reviewed retrospectively. Patients' demographics, etiology of splenic vein thrombosis, embolization level and techniques, adverse events after embolization, and rebleeding rate were reviewed. Results : : Twenty-two patients received splenic artery embolization for bleeding gastric varices in the setting of LPH. Three patients who underwent subsequent splenectomy were excluded. Median age was 44.5 years (range: 27-83 years) and 13 were male. Etiologies of splenic vein thrombosis were pancreatitis (n = 9), chronic liver disease (n = 6), and hematologic abnormalities (n = 4). Technical success was achieved in all 19 patients. Embolization level and material were as follows: proximal splenic artery coil embolization (n = 9), partial splenic parenchymal embolization with coils or particles (n = 7), and total parenchymal embolization with particles (n = 3). Procedure-related adverse events developed in 2 patients (one pleural effusion and one ileus with leukocytosis). During the median follow-up of 55 months (range, 7-165 months), two rebleeding events occurred 29 and 111 months after initial embolization, and both were successfully treated with repeat splenic artery embolization (n = 1) and transhepatic variceal embolization (n = 1). Conclusion : : Splenic artery embolization for variceal bleeding secondary to LPH is safe and feasible. A total of 10.5% patients had delayed rebleeding more than 2 years after the index procedure, and both were successfully managed by repeat splenic artery embolization or transhepatic variceal embolization.

Keywords

• embolization
• therapeutic; esophageal and gastric varices; hemorrhage; sinistral portal hypertension; splenic artery