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Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience

Background: Hypersplenism, portal hypertension, and ascites have been seen after liver transplants. Patients are usually treated medically with refractory patients potentially undergoing splenectomy. Splenic artery embolism (SAE) is an alternative that can be performed to limit the surgical interven...

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Autores principales: Obri, Mark S, Kamran, Wasih, Almajed, Mohamed Ramzi, Eid, Daniel, Venkat, Deepak
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166421/
https://www.ncbi.nlm.nih.gov/pubmed/37168407
http://dx.doi.org/10.7759/cureus.38599
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author Obri, Mark S
Kamran, Wasih
Almajed, Mohamed Ramzi
Eid, Daniel
Venkat, Deepak
author_facet Obri, Mark S
Kamran, Wasih
Almajed, Mohamed Ramzi
Eid, Daniel
Venkat, Deepak
author_sort Obri, Mark S
collection PubMed
description Background: Hypersplenism, portal hypertension, and ascites have been seen after liver transplants. Patients are usually treated medically with refractory patients potentially undergoing splenectomy. Splenic artery embolism (SAE) is an alternative that can be performed to limit the surgical intervention that may have the benefit of improving portal hypertension. Few studies have studied the effect on main portal vein (MPV) velocities and hepatic artery resistive indices (HARIs) which may be beneficial as markers of portal hypertension. Purpose: This study aims to evaluate the efficacy and safety of interventional radiology (IR)-guided SAE for the management of portal hypertension in patients who have had liver transplants. Methods: A retrospective analysis was conducted on liver transplant patients who had undergone IR-guided SAE post-transplant at a single tertiary transplant center from 2012 to 2022. The primary outcome of intervention efficacy was quantified by peak HARIs and MPV velocities. Ultrasound with Doppler obtained before and after the intervention was reviewed for these parameters. Secondary outcomes included adverse events at the time of the procedure and within one year of the procedure, the need for splenectomy, and spleen size. Results: Twenty-eight patients met the criteria for inclusion. The mean age of patients was 52.5 years (21-71 years) and the time after transplant was 149.5 days (2-1588 days). About 96.4% of SAEs were technically successful (n=27). Twenty-one patients had MPV velocities available, and 24 had peak HARIs available. In these patients, HARIs decreased by an average of 0.063 (95% CI 0.014-0.112) after SAE. MPV velocity decreased by an average of 47.2 cm/s (95% CI 27.3-67.1) after SAE. About 10.4% of patients (n=3) developed a procedure-related complication, all of which were femoral access site aneurysms. No (0) patients suffered from bleeding, infections, or abscesses after the procedure. About 10.7% of patients (n=3) required splenectomy after SAE: one splenectomy was due to technical failure and two were due to refractory symptoms. Conclusion: We performed one of the first analyses on MPV and RI and showed that our patients saw an improvement post-embolization with a theoretical improvement in portal hypertension. The complication rate and risk of infection seem to be acceptable risks, making SAE a feasible option for management.
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spelling pubmed-101664212023-05-09 Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience Obri, Mark S Kamran, Wasih Almajed, Mohamed Ramzi Eid, Daniel Venkat, Deepak Cureus Internal Medicine Background: Hypersplenism, portal hypertension, and ascites have been seen after liver transplants. Patients are usually treated medically with refractory patients potentially undergoing splenectomy. Splenic artery embolism (SAE) is an alternative that can be performed to limit the surgical intervention that may have the benefit of improving portal hypertension. Few studies have studied the effect on main portal vein (MPV) velocities and hepatic artery resistive indices (HARIs) which may be beneficial as markers of portal hypertension. Purpose: This study aims to evaluate the efficacy and safety of interventional radiology (IR)-guided SAE for the management of portal hypertension in patients who have had liver transplants. Methods: A retrospective analysis was conducted on liver transplant patients who had undergone IR-guided SAE post-transplant at a single tertiary transplant center from 2012 to 2022. The primary outcome of intervention efficacy was quantified by peak HARIs and MPV velocities. Ultrasound with Doppler obtained before and after the intervention was reviewed for these parameters. Secondary outcomes included adverse events at the time of the procedure and within one year of the procedure, the need for splenectomy, and spleen size. Results: Twenty-eight patients met the criteria for inclusion. The mean age of patients was 52.5 years (21-71 years) and the time after transplant was 149.5 days (2-1588 days). About 96.4% of SAEs were technically successful (n=27). Twenty-one patients had MPV velocities available, and 24 had peak HARIs available. In these patients, HARIs decreased by an average of 0.063 (95% CI 0.014-0.112) after SAE. MPV velocity decreased by an average of 47.2 cm/s (95% CI 27.3-67.1) after SAE. About 10.4% of patients (n=3) developed a procedure-related complication, all of which were femoral access site aneurysms. No (0) patients suffered from bleeding, infections, or abscesses after the procedure. About 10.7% of patients (n=3) required splenectomy after SAE: one splenectomy was due to technical failure and two were due to refractory symptoms. Conclusion: We performed one of the first analyses on MPV and RI and showed that our patients saw an improvement post-embolization with a theoretical improvement in portal hypertension. The complication rate and risk of infection seem to be acceptable risks, making SAE a feasible option for management. Cureus 2023-05-05 /pmc/articles/PMC10166421/ /pubmed/37168407 http://dx.doi.org/10.7759/cureus.38599 Text en Copyright © 2023, Obri et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Obri, Mark S
Kamran, Wasih
Almajed, Mohamed Ramzi
Eid, Daniel
Venkat, Deepak
Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience
title Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience
title_full Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience
title_fullStr Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience
title_full_unstemmed Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience
title_short Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience
title_sort splenic artery embolism in liver transplant patients: a single-center experience
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166421/
https://www.ncbi.nlm.nih.gov/pubmed/37168407
http://dx.doi.org/10.7759/cureus.38599
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