Endovascular procedures at the complex management in patients with portal hypertension and variceal bleeding

Abstract

For today, endovascular procedures, such as embolization of splenic artery, transjugular intrahepatic shunt, and retrograde transvenous obliteration with balloon occlusion are widely applied in the treatment and prophylaxis of variceal bleeding in patients with portal hypertension. Splenomegaly with the development of hypersplenism is one of complications of portal hypertension in patients with liver cirrhosis, which can negatively be influenced on clinical course. Due to that, it can be assumed that the management of hypersplenism in patients with portal hypertension with the applying of splenic artery embolization, could be improve the results of treatment of this group of patients. Purpose - to summarize the own experience of the applying of splenic artery embolization in the complex therapy in patients with portal hypertension that complicated by the variceal bleeding. Materials and methods. This study based on the results of treatment of 36 patients, in which the embolization of splenic artery was applied in the complex management (conventional treatment and endoscopic ligation of varices). The classic method of “chronic” occlusion was used for the embolization. The embolization on the level of the initial portion of the main trunk of splenic artery was performed in 30 (83.3%) of patients. Due to the anatomical peculiarities of vasculature, embolization was performed on the level of middle part of splenic artery in 6 (16.7%) of patients. The effectiveness of the treatment was evaluated by the changes of complete blood count indices and ultrasonography results. Statistical analysis was performed using the program SPSS Statistic for Windows, version 15.0 (IBM Corp., Armonk, NY, USA). Results. The middle age of patients was 55.8±1.6 years. The middle value of Child-Turcotte-Pugh criterion was 2.44±0.08, and MELD score was 16.36±0.99 value. Conclusions. The applying of splenic artery embolization that combined with conventional therapy and endoscopic ligation of varices is appropriate and justified. Embolization of the splenic artery promotes to decrease of appearance of hypersplenism in patients with the portal hypertension with positive influence on follow-up clinical course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.