Partial splenic embolization in patients with cirrhosis: Comparison of < 50% versus > 50% infarction strategy.

BACKGROUND

Splenomegaly commonly occurs in portal hypertension due to cirrhosis, potentially causing leukopenia, thrombocytopenia and portal hypertension. Partial splenic artery embolization (PSE) serves as a substitute for splenectomy, given the significant risks associated with surgery in cirrhotic patients. In addition to improving hematologic indices, PSE may indirectly benefit liver-related outcomes and reduce portal hypertension complications.

METHODS

The objective of this study was to assess the short-term (One-month) and long-term (24-month) impact on hematological parameters and liver function post-PSE, to compare the hematological parameters and liver function in patients with different volumes of spleen embolization (group A-< 50% and group B-> 50%) and to evaluate the changes in the status of esophageal varices and Child-Turcotte-Pugh (CTP) score after PSE. A review of medical records of 47 patients who underwent PSE between March 2011 and March 2023 was conducted from the hospital database. PSE was primarily indicated for hypersplenism-related complications in cirrhotic patients and to improve blood counts for safer anti-viral therapy in hepatitis C virus (HCV) infection. Information regarding patient demographics, underlying liver disease, indication for PSE and baseline laboratory values was noted at short-term (One month) and long-term duration (24 months).

RESULTS

Short-term follow-up revealed an 80 ± 11.8% increase in total leukocyte count (TLC) and a 143 ± 39% rise in platelet count, while long-term follow-up showed a 56 ± 8.6% increase in TLC and an 83.7 ± 21% increase in platelet count. Albumin levels rose from 3.0 ± 0.6 g/dL before PSE to 3.3 ± 0.58 g/dL (10.4 ± 1.4% increase) in the long term. Cumulative variceal bleeding episodes decreased from 2.1 to 0.72, alongside an improved CTP score from baseline.

CONCLUSION

PSE leads to sustained hematologic improvement and favorable changes in liver-related parameters. Embolization limited to < 50% achieves comparable long-term benefits with fewer complications, supporting its role as a safer therapeutic strategy in cirrhotic patients with hypersplenism.