Long-Term Efficacy of Partial Splenic Embolization In

Children
RFS Journal Primer

Quick Summary
BOTTOM LINE

Partial splenic embolization (PSE) is a safe and effective procedure for improving hematologic
indices in children with severe hypersplenism associated with portal hypertension

MAJOR POINTS

PSE is a reasonable alternative in patients with severe hypersplenism as there is significant risk of
sepsis after surgical splenectomy

Average volume of spleen embolized was 70.1%

Hematologic indices initially improved in all 36 patients after PSE

Long-term efficacy (platelet counts remaining normal throughout follow-up) was shown in 70% of
survivors

CRITICISM

Retrospective nature of study

Sample size: 36 patients over 17 years

Study design
Single Center Retrospective Review

36 patients with 41 PSEs performed

1984-2001

INCLUSION CRITERIA

Splenomegaly was caused by hypersplenism secondary to portal hypertension

Platelet counts were less than 100,000/mm3 with ongoing thrombocytopenia

Bleeding complications present (epistaxis, GI bleed, etc.)

EXCLUSION CRITERIA

Did not fulfill all three of the above inclusion criteria

Purpose

To elucidate the role of partial splenic

embolization procedures utilizing long-term
outcome assessment in terms of the
recurrence of thrombocytopenia

Intervention

Antibiotic prophylaxis begins 6 hours prior to embolization with 1,000,000 IU Penicillin G IM

and gentamycin 3 mg/kg
Abx continued for 5 days

Gelfoam cut into 2 x 2 mm pieces and suspended in antibiotic solution of penicillin G and
gentamycin immediately before intra-arterial injection

Femoral or axillary artery approach was utilized for splenic artery catheterization

Depending on spleen size, 20-40 pieces of Gelfoam were injected

Extent of infarction monitored fluoroscopically and radiographically

Embolization stopped when about two-thirds of splenic parenchyma was ablated

Solution of antibiotics used for injection of embolic particles as opposed to contrast medium

Percentage of embolized volume was precisely evaluated using technetium 99m Sn colloid
splenic scintigram

Outcome

Hematologic indices improved in all 36 patients after PSE, and its long-term efficacy was
shwon in 70% of survivors

Percent of embolized splenic volume was not statistically significant between patients with
and without recurrence of thrombocytopenia (68% vs 71%)

Platelet counts before PSE in patients with and without recurrent thrombocytopenia were not
signiciant (61,200 vs 62,600, respectively)

The peak value of platelet counts of patients without recurrence of thrombocytopenia was
significantly greater than those with recurrence (453,100 vs 275,600, P<.01)
Recurrence

No recurrence

11

25

Alive w/o liver tx

19

Dead

Liver tx

F/u period (mo)

6.0 +/- 2.7

5.9 +/- 4.2

Not significant

Embolized vol (%)

68 +/- 13

71 +/- 14

Not significant

61.2+/- 2.1

62.6 +/- 19.4

Not significant

Peak Plt

275.6 +/- 92.2

453.1 +/- 194.1

<.01

Final Plt

75.2 +/- 21.0

180.0 +/- 75.0

<.001

# Cases

P value

Outcome

Plt pre-PSE

Not significant

Credits

SUMMARY BY:

Alexander Copelan, M.D. R3 PGY-4

Department of Radiology
William Beaumont Health System
FULL CITATION:
Nio M, Hayashi Y, Sano N, Ishii T, Sasaki H, Ohi R. Long-term Efficacy of Partial Splenic Embolization in Children. Journal of Pediatric
Surgery 2003; 38(12):1760-1762

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