PARTIAL SPLENIC EMBOLIZATION FOR THE TREATMENT OF HYPERSPLENISM IN CIRRHOSIS

Hypersplenism is of great relevance in the management of cirrhosis bec ause of the widespread use of myelodepressant drugs such as interferon or antineoplastic agents. Because no standard therapy exists for this complication, we have evaluated the efficacy and risks of splenic emb olization in the treatment of hypersplenism in cirrhosis. Partial sple nic embolization was performed in 40 consecutive patients with the fol lowing indications: 25 patients with active viral cirrhosis before int erferon therapy, 8 patients with unresectable hepatocellular carcinoma before antineoplastic chemotherapy and 7 patients with thrombocytopen ia associated with spontaneous bleeding events, with high risk of cent ral nervous system hemorrhage or facing major surgery. After selective catheterization of the splenic artery, partial splenic embolization w as performed by means of repeated injections of gelatin sponge until a 40% to 60% reduction in the splenic blood flow was achieved. After pa rtial splenic embolization a significant and sustained increase in pla telet and white blood cell count was observed during the follow-up per iod (mean = 13.9 +/- 2.2 mo; range = 1 to 36 mo). The goal of partial splenic embolization was achieved in all but two patients in whom a do se reduction of interferon was needed. Hypersplenism relapsed in only seven patients, and all of them exhibited an embolization of less than 50% of the splenic mass. Postembolization syndrome was the main side effect, but no life-threatening complications were detected. In conclu sion, partial splenic embolization is a safe and effective therapy of hypersplenism in cirrhosis.