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Splenic Embolization for hypersplenism, portal hypertension and liver transplant patients Jochen Fuchs Department for Diagnostic and Interventional Radiology Leipzig University Hospital

Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

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Page 1: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Splenic Embolization for

hypersplenism, portal hypertension and liver transplant patients

Jochen Fuchs Department for Diagnostic and Interventional Radiology

Leipzig University Hospital

Page 2: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Disclosure

Speaker name:

Jochen Fuchs

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest x

Page 3: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Indications

● Splenic trauma

● Hypersplenism

● Portal hypertension

● Splenic artery aneurysm

● Splenic artery steal syndrome (SASS)

● Preoperative (splenectomy in high risk

patients)

Page 4: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Technique

splenic artery

embolization

● occlusion of the

splenic artery

● proximal catheter

position

● coils or plug

vs. (partial) splenic

embolization

● devascularization of

the parenchyma

● peripheral catheter

position

● particles or liquids

Page 5: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Anatomy

Page 6: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Materials

● how to get there

– Celiac Trunk: Cobra, SIM 1 or 2 , Shepherd Hook

– 4F (for AVP 6F)

– microcatheter (for particles): 2.4 / 2.7 F

– brachial access !

● Embolization agents

– particles (PVA, gelatine microspheres) 300-700 µm

– gelfoam

– glue (cyanoacrylate)

– coils or vascular plug

Page 7: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Madoff et al, Radiographics 2005

Hypersplenism

Why embolization ?

● alternative to surgical removal

● preserving immunological function

How ?

● Devascularization by peripheral embolization (~ 2/3)

Page 8: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Hypersplenism

Why embolization ?

● alternative to surgical removal

● preserving immunological function

How ?

● Devascularization by peripheral embolization (~ 2/3)

Results 1-4

● shrinking of the spleen ~ 50-60 %

● platelet count rises (also WBC)

1 He et al , WJG 2011 2 Romano et al, EJR 2003 3 Sangro et al, Hepatology 1993 4 Palsson et al, Langenbecks Arch Surg 2003

Page 9: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)
Page 10: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)
Page 11: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Portal Hypertension

Why embolization ?

● alternative to TIPS (e.g. hepatic encephalopathy)

● supplementary to BRTO

How ?

● Devascularization by peripheral embolization (~ 2/3)

Results 5-8

● lowering portal pressure and reducing variceal

bleeding episodes

(Balloon-occluded Retrograde Transvenous Obliteration)

5 Koconis et al, SIR 2007 6 Chikamori et al, WJS 2010 7 Yoshimatsu et al, JVIR 2012 8 Zannini et al, Arch Surg 1983

Page 12: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Liver transplant patients

Why embolization ?

● after OLT in patients with Splenic Artery Steal Syndrome

● before OLT in patients high probability for SASS

(diameter splenic>hepatic artery) – instead of ligation

How ?

● proximal embolization with coils / plug

Results 9-11

● improving arterial perfusion of the graft

● preventing ischemic biliary complications

9 Uflacker et al, CVIR 2002 10 Nüssler et al, Liver Transpl 2003 11 Vogl et al, Röfo 2001 12 Valente et al, Transplantation 1996

Page 13: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)
Page 14: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Thank you for your attention !

Page 15: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)
Page 16: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)
Page 17: Splenic Embolization · Hypersplenism Why embolization ? alternative to surgical removal preserving immunological function How ? Devascularization by peripheral embolization (~ 2/3)

Splenic Embolization for

hypersplenism, portal hypertension and liver transplant patients

Jochen Fuchs Department for Diagnostic and Interventional Radiology

Leipzig University Hospital