The first experience of partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis

A. V. Shabunin; V. V. Bedin; P. A. Drozdov; O. N. Levina; V. A. Tsurkan; O. S. Zhuravel; S. A. Astapovich

doi:10.16931/1995-5464.2021-3-97-103

The first experience of partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis

A. V. Shabunin, V. V. Bedin, P. A. Drozdov, O. N. Levina, V. A. Tsurkan, O. S. Zhuravel, S. A. Astapovich

https://doi.org/10.16931/1995-5464.2021-3-97-103

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Abstract

Aim. To assess the efficacy and safety of interventional endovascular partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis.

Material and methods. From September 2019 to March 2020, 5 partial spleen embolizations were performed at the surgical clinic of the Botkin Hospital. The indication was the impossibility of conducting courses of regional chemotherapy for primary liver cancer in 2 patients with cirrhosis, portal hypertension, hypersplenism, thrombocytopenia, in 3 patients – the impossibility of conducting adequate antiviral therapy with cirrhosis as a result of chronic viral hepatitis C. The platelet count was < 25 thousand/μl (19.34 ± 1.34 thousand/μl) in all patients at the time of the procedure. The median spleen volume was 1967.54 ± 476.13 (1324.34–2163.54) cm3 . We used Progreat® Terumo 2.8 Fr microcatheter 130 cm for catheterization branches of the splenic artery. Endovascular embolization was performed with microspheres 600 ± 75 nm – 2 ml before occlusion. Computed tomography scan of abdominal cavity with intravenous contrast enhancement and laboratory test of platelet levels were performed. Follow up of patients was carried out at 1, 3 and 6 months after this intervention.

Results. The postoperative period in all patients was uncomplicated. Postembolization syndrome (pain, hyperthermia) developed in the early postoperative period in all patients on the next day after the procedure. Computed tomography scan of the abdominal cavity revealed areas of an irregular shape of low density that did not accumulate a contrast agent. The duration of hospitalization was 7.63 ± 3.32 (5–11) days. There were not in-hospital and 30-day mortality in our study.

Conclusion. The first experience of endovascular partial spleen embolization showed its safety and efficacy in the correction of thrombocytopenia in patients with liver cirrhosis.

Keywords

spleen, liver, cirrhosis, portal hypertension, partial embolization, liver cirrhosis, thrombocytopenia

About the Authors

A. V. Shabunin

Botkin City Clinical Hospital; Russian Medical Academy of Continuous Professional Education
Russian Federation

Aleksey V. Shabunin – Doct. of Sci. (Med.), Professor, Corresponding Member of RAS, Head of the Department of Surgery of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Chief Physician of the Botkin City Clinical Hospital