Embolization of the Splenic Artery in Nontraumatized Patients
This section provides a comprehensive procedural report for embolization of the splenic artery in nontraumatized patients procedure with up-to-date explanatory notes, synopsis of the indications and contraindications, and potential complications in an org
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Bedros Taslakian and Sela Batouzian
INTRODUCTION
COMMON INDICATIONS [1–4]
Catheter-directed splenic embolization can be used to induce global or segmental infarction of the splenic tissue and has been advocated for the intentional infarction of splenic tissue to reduce its consumptive activity. Efficient infarction of splenic tissue is achieved by embolization of the intrasplenic branches due to the presence of collateral circulation principally via the short gastric arteries and because intrasplenic arterial vascularization is represented by terminal vessels. Partial catheter-mediated infarction of the splenic tissues allows maintenance of the spleen’s immunologic function while reducing sequestration and destruction of the blood elements and preoperative reduction of splenic volume in massive splenomegaly. It has shown better results and significantly lower complication rate when compared to complete splenic embolization.
• Hypersplenism and pancytopenia secondary to hematologic disorders (e.g., idiopathic thrombocytopenic purpura, thalassemia, hereditary spherocytosis, autoimmune hemolytic anemia) • Liver cirrhosis associated with portal hypertension (hypersplenism and pancytopenia, recurrent gastroesophageal visceral hemorrhage, hepatic encephalopathy) • Pancytopenia secondary to lymphoma and leukemia • Hypersplenism and pancytopenia secondary to congenital diseases (e.g., Gaucher disease, biliary atresia) • Hypersplenism and pancytopenia secondary to portal vein thrombosis • Chemotherapy-induced bone marrow suppression or hypersplenism leading to pancytopenia • Intolerance to immunosuppressive agents (i.e., pancytopenia) • Hypersplenism and pancytopenia secondary to idiopathic hypersplenism • Before laparoscopic splenectomy in selected group of patients (e.g., high operative risk, refusal of blood transfusion)
B. Taslakian (&) Department of Radiology, New York University Langone Medical Center, 660 First Ave, New York, NY 10016, USA e-mail: [email protected] S. Batouzian Coronary Care Unit (CCU), Clemenceau Medical Center (CMC), Beirut, Lebanon e-mail: [email protected]
© Springer International Publishing Switzerland 2016 B. Taslakian et al. (eds.), Procedural Dictations in Image-Guided Intervention, DOI 10.1007/978-3-319-40845-3_93
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COMMON CONTRAINDICATIONS [1–4] • Past history of allergy to intravenous contrast media or impaired renal function (consider CO2 for angiography) • Pregnancy • Uncorrected coagulopathy • Acute or chronic infection of spleen • Systemic infection • Massive splenomegaly (consider staged partial embolization)
POSSIBLE COMPLICATIONS [1–4] General (angiography-related) complications: • Hemorrhage (puncture-site hematoma, retroperitoneal hematoma if “high” puncture above inguinal ligament) • Pseudoaneurysm (superficial femoral artery “low” puncture) • Arteriovenous fistula (puncture-site artery) • Thrombosis of the femoral artery • Distal embolization • Contrast-induced allergic reaction • Contrast-induced nephropathy • Arterial perforation or dissection • Cat
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