Introduction |
Splenic artery embolization (SAE) effectively increases hematologic indices in patients with hypersplenism; particularly in patients who are not good candidates for splenectomy.
In addition to cirrhotic liver disease, SAE has been utilized to treat several hematologic, vascular and rheumatologic disorders. Embolization may be performed alone or in combination with other interventions, such as retrograde transvenous variceal obliteration. |
Indications |
Other less frequent indications
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Contraindication |
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Pre-Procedure |
Vaccination
Medication Patients on small molecule multi-tyrosine kinase inhibitors with anti-VEGF activity (Sorafenib, Sunitinib and Regorafenib), significantly lymphopenic, or on Avastin: discontinuing these medications should be discussed with oncology. SAE may be considered with 2 weeks of antibiotics. Anticoagulation SAE of massive spleen is associated with splenic/portal venous thrombosis. Short-term anticoagulation with 2-weeks of Enoxaparin and antibiotics should be considered. |
Labs |
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Technique |
Prophylactic antibiotics
Practical choice of antibiotics for proximal splenic artery embolization (PSAE):
Practical choice of antibiotics for distal partial splenic artery embolization (DSAE):
General Protocol
Proximal splenic artery embolization (PSAE)
Proximal splenic artery embolization (PSAE) In PSAE, embolization is performed distal to the dorsal pancreatic artery. This is equivalent to splenic artery ligation where splenic perfusion is maintained through collaterals. Used frequently for trauma. Distal splenic artery embolization (DSAE)
Embolic agents
AVP 2
Sheaths
AVP 4
Coils (e.g. 2D Interlock 18 Fibered IDC coils in 2D Helical and Diamond shapes, 2 mm-14 mm with variable lengths).
Embolization Volume
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Figure
Complications |
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Post-Procedure |
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Follow-up |
Clinical & Laboratory Follow-up
Imaging Follow-up
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References |
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