Partial Splenic Embolization in Cirrhotic Patients

Partial splenic embolization (PSE) has emerged as a minimally invasive interventional radiology technique to manage hypersplenism and its sequelae in patients with cirrhosis and portal hypertension. By selectively occluding branches of the splenic artery, a controlled infarction of 50–70 percent of splenic tissue is induced, reducing splenic sequestration of blood elements and alleviating thrombocytopenia and leukopenia. Clinically, PSE may be performed as a stand-alone procedure or in combination with endoscopic therapies for variceal bleeding, transarterial chemoembolization for hepatocellular carcinoma, or to permit continuation of systemic chemotherapy. The reduction in splenic volume also modifies portal haemodynamics, potentially decreasing the risk of variceal rebleeding. Beyond haematological improvements, PSE has been associated with modulation of host immunity and improvements in biochemical indices of liver function. Common post-embolization complications include transient fever, abdominal pain, post-embolization syndrome and, less frequently, portal vein thrombosis or splenic abscess. Ongoing refinements in embolic agents, periprocedural pharmacological strategies and patient selection criteria seek to maximise efficacy while minimising morbidity.

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Partial Splenic Embolization in Cirrhotic Patients publication trend

The graph below shows the total number of articles in partial splenic embolization in cirrhotic patients across all publications each year (not limited to Nature Index journals).

Technical terms

Partial splenic embolization: Endovascular occlusion of selected splenic artery branches to infarct part of the spleen, reducing hypersplenism.

Hypersplenism: Overactivity of the spleen leading to excessive sequestration and destruction of blood cells, causing cytopenias.

Portal hypertension: Elevated pressure in the portal venous system, commonly secondary to cirrhosis, which promotes development of varices.

Embolic material: Substance—such as gelatin, microspheres or polyvinyl alcohol—used to occlude blood vessels during embolization.

Variceal rebleeding: Recurrence of haemorrhage from dilated oesophageal or gastric veins under portal hypertension.

Portal vein thrombosis: Development of a blood clot within the portal vein, a recognised complication after splenic artery embolization.

References

1. Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial. Hepatology International (2021).
2. Clinical Application of Partial Splenic Embolization. The Scientific World JOURNAL (2014).
3. Host Immunological Effects of Partial Splenic Embolization in Patients with Liver Cirrhosis. Journal of Immunology Research (2018).
4. Partial splenic embolization to permit continuation of systemic chemotherapy. Cancer Medicine (2016).
5. Comparison of three embolic materials at partial splenic artery embolization for hypersplenism: clinical, laboratory, and radiological outcomes. Insights into Imaging (2021).
6. Efficacy and safety of heparin plus dexamethasone after partial splenic embolization for liver cirrhosis with massive splenomegaly. BMC Gastroenterology (2022).
7. Effect of partial splenic embolization on transarterial chemoembolization for hepatocellular carcinoma with hypersplenism. Medicine (2021).