A new volumetric evaluation of partial splenic embolization for hypersplenism in biliary atresia

Background/Purpose: Partial splenic embolization (PSE) has become an import ant therapeutic modality in the management of hypersplenism in biliary atre sia (BA). Fifty percent to 80% of spleen is usually devascularized by embol ization. The functional outcome, however, has not been correlated with embo lized volume of the spleen. The authors propose a new, reliable method of p redicting functional outcome using non-embolized volume of the spleen (NEVS ) as an index. Methods: Between January 1993 and July 2000, 11 children with BA (2 boys an d 9 girls, aged 5 to 10 years) underwent 12 PSE procedures. The follow-up p eriod ranged from 6 to 77 months. The NEVS was calculated by enhanced compu ted tomography (CT) images, and an index was calculated by dividing NEVS wi th the predicted splenic volume for body weight (standardized NEVS ratio) 2 weeks after PSE. Results: Splenic volumes before PSE ranged from 312 to 1,201 cm(3) (mean, 8 75.8 cm(3)). NEVS ranged from 140 to 485 cm(3) (mean, 340 cm(3)). Standardi zed NEVS ratio ranged from 2.21 to 7.22 (mean, 4.25). The platelet counts w ith standardized NEVS ratio below 5.0 (group I) and above 5.0 (group II) we re 15.1 x 10(4)/mm(3) and 7.2 x 10(4)/mm(3) at 6-month followup, respective ly. Conclusions: (1) Nonembolized volumetric evaluation is useful in predicting the functional outcome of PSE. (2) Reembolization is indicated for the pat ients with standardized NEVS above 5.0. J Pediatr Surg 36:1615-1616. Copyri ght (C) 2001 by W.B. Saunders Company.