Partial Splenic Artery Embolization to Treat Portal Hypertension

Portal hypertension (PH) commonly occurs in the setting of underlying liver disease and can precipitate variceal bleeding and ascites among other complications. Traditionally, PH is managed with medication or lifestyle changes with refractory cases treated with transjugular intrahepatic portosystemic shunts or splenectomy. Partial splenic artery embolization (PSE) is an alternative treatment which may reduce PH by decreasing splenic vein inflow into the portal vein. In this article, we review the efficacy of PSE and present illustrative cases with a focus on technical and clinical considerations for embolization. We queried the PubMed database from August 1976 to September 2021 for clinical studies of PSE for the treatment of portal hypertension. For each article, the author, year, title, study design, number of patients, age, sex, liver function, technical considerations, adverse effects, and outcomes were recorded. We also review two successful and unsuccessful cases from our institution. A total of 12 studies were identified with 258 patients undergoing 290 PSE treatments. The mean age of patients was 44.1 years (range: 6–77). Most patients had well-compensated liver disease (Child–Pugh (CP) A; 35.1%) or significant functional compromise (CP-B; 44.4%), but a few had decompensated disease (CP-C; 8.9%). The majority (91.7%) of procedures were performed distally within the splenic artery, and on average, 59.5% (20–100) of the spleen underwent infarction. Common complications included symptoms of postembolization syndrome such as abdominal pain (58.5%) and fever (53.2%) as well as atelectasis (9.0%). Five PSE procedures (1.7%) resulted in death secondary to pleuropneumonia, splenic abscess, sepsis, intracranial hemorrhage, and pulmonary embolism, respectively. PSE is an effective but often underutilized treatment for PH. These benefits have risk for minor complications including postembolization syndrome and major complications such as splenic abscess formation. This article will introduce the reader to important technical and clinical considerations regarding PSE.