Splenic Embolization

  • Demetrios G. Spigos
  • Walter S. Tan
  • Martin F. Mozes
  • Kevin Pringle
  • Ioulios Iossifides
  • A. Benedict Cosimi
Conference paper

Abstract

While transcatheter embolization of the spleen has shown promise in the treatment of a wide spectrum of disorders, the incidence of serious complications with this technique has limited its use as an alternative to operative splenectomy. In our institution 41 patients were treated with a modified technique involving partial splenic embolization, careful antibiotic prophylaxis, and adequate pain control. There was no mortality and only few instances of clinically significant complications: a splenic abscess in one patient, pancreatitis in one patient, severe pleural effusions in two patients, and pneumonia in five patients

Key words

Embolism, therapeutic Catheters and catheterization Arterial blockade Spleen Interventional radiology 

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References

  1. 1.
    Djindjian, R., Cophignon, J., Rey, A., Theron, J., Merland, J.J., Houdart, R.: Superselective arteriographic embolization by the femoral route in neuroradiology: Study of 50 cases-Ill, Embolization in craniocerebral pathology. Neuroradiology 6: 143–153, 1973PubMedCrossRefGoogle Scholar
  2. 2.
    Serbinenko, F. A.: Balloon catheterization and occlusion of major cerebral vessels. J. Neurosurg. 41: 125–145, 1974PubMedCrossRefGoogle Scholar
  3. 3.
    Sokoloff, J., Wickbom, I., Ingmar, X., McDonald, D., Brahme, F., Goergen, T.G., Goldberger, L.E.: Therapeutic percutaneous embolization in intractable epistaxis. Radiology 11: 285–287, 1974Google Scholar
  4. 4.
    Porstmann, W., Wierny, L., Warneke, H., Gertsberger, G., Romaniuk, P.A.: Catheter closure of patent ductus arteriosus: 62 cases treated without thoracotomy. Radiol. Clin. North Am. 9: 203–218, 1971PubMedGoogle Scholar
  5. 5.
    Rösch, J., Dotter, C.T., Brown, M.J.: Selective arterial embolization: A new method for control of acute gastrointestinal bleeding. Radiology 102: 303–306, 1972PubMedGoogle Scholar
  6. 6.
    Reuter, S.R., Chuang, V.P., Bree, R.L.: Selective arterial embolization for control of acute gastrointestinal bleeding. Radiology 102: 303–306, 1972Google Scholar
  7. 7.
    Goldman, M.L., Land, W.C., Bradley, E.L., Anderson, J.: Transcatheter therapeutic embolization in the management of massive upper gastrointestinal bleeding. Radiology 120: 513–521, 1976PubMedGoogle Scholar
  8. 8.
    Bookstein, J.J., Naderi, M.J., Walter, J.F.: Transcatheter embolization for lower gastrointestinal bleeding. Radiology 127: 345–349, 1978PubMedGoogle Scholar
  9. 9.
    Almgard, L.E., Fernstrom, L., Haverling, M., Ljungqvist, A.: Treatment of renal adenocarcinoma by embolic occlusion of the renal circulation. Br. J. Urol. 45: 474–479, 1973PubMedCrossRefGoogle Scholar
  10. 10.
    Miller, F.J., Mortel, R., Mann, W.J., Jahshan, A.E.: Selective arterial embolization for control of hemorrhage in pelvic malignancy: Femoral and brachial catheter approaches. Am. J. Roentgenol. 126: 1028–1032, 1976Google Scholar
  11. 11.
    Woodside, J., Schwarz, H., Bergreen, P.: Peripheral embolization complicating bilateral renal infarction with Gelfoam. Am. J. Roentgenol. 126:1033 1034, 1976Google Scholar
  12. 12.
    Gang, D.L., Dole, K.B., Adelman, L.S.: Spinal cord infarction following therapeutic renal artery embolization. JAMA 237: 2841–2842, 1977PubMedCrossRefGoogle Scholar
  13. 13.
    Tegtmeyer, C.J., Smith, T.H., Shaw, A., Barwick, K.W., Katt-winkel, J.: Renal infarction: A complication of Gelfoam embolization of a hemangioendothelioma of the liver. Am. J. Roentgenol. 128: 305–307, 1977Google Scholar
  14. 14.
    Bradley, E.L., Goldman, M.L.: Gastric infarction after therapeutic embolization. Surgery 79: 421–424, 1976PubMedGoogle Scholar
  15. 15.
    Braf, Z.F., Koontz, W.W.: Gangrene of bladder: Complication of hypogastric artery embolization. Urology 9: 670–671, 1977PubMedCrossRefGoogle Scholar
  16. 16.
    Goldstein, H.M., Wallace, S., Anderson, J.H., Bree, R.L., Giantruco, C: Transcatheter occlusion of abdominal tumors. Radiology 120: 539–545, 1976PubMedGoogle Scholar
  17. 17.
    Castaneda-Zuniga, W.R., Hammerschmidt, D.E., Sanchez, R., Amplatz, K.: Non-surgical splenectomy. Am. J. Roentgenol. 129: 805–811, 1977Google Scholar
  18. 18.
    Wholey, M.H., Chamorro, H., Rao, G., Chapman, W.: Splenic infarction and spontaneous rupture of the spleen following therapeutic embolization. Cardiovasc. Radiol. 1: 249–253, 1978PubMedCrossRefGoogle Scholar
  19. 19.
    Witte, C.L., Ovitt, T.W., Van Wyck, D.B., Witte, M.H., O’Mara, R.E., Woolfenden, J.M.: Ischemic therapy in thrombocytopenia from hypersplenism. Arch. Surg. 111: 1115–1121, 1976PubMedCrossRefGoogle Scholar
  20. 20.
    Zimmermann, H.B., Burger, K., Winter, H., Buchalik, X., Schimmelpfennig, W., Wack, R., Sielaff, F., Ihle, E.: Ausschaltung der Milzfunktion durch Milzarterien-Embolisation — Transvasale Therapie des Hypersplenismus bei Pfortaderhochdruck. Dt. Gesundh.-Wesen 34: 164–166, 1979Google Scholar
  21. 21.
    Pereiras, R., Schiff, E., Barkin, J., Hutson, D.: The role of interventional radiology in diseases of the hepatobiliary system and the pancreas. Radiol. Clin. North Am. 17: 555–605, 1979PubMedGoogle Scholar
  22. 22.
    Goldman, M.L., Philip, P.K., Sarrafizadeh, M.S., Gordon, I.J., Sarfek, J.I., Salam, A., Galambos, J.T., Powers, S.R., Smith, R.P.: Medical splenectomy by transcatheter arterial embolization with bucrylate. Presented at the 65th Annual meeting of the Radiologic Society of North America, Atlanta, Georgia, 1979Google Scholar
  23. 23.
    Trojanowski, J.Q., Harriet, T.J., Athanasoulis, C.A., Greenfield, A.J.: Hepatic and splenic infarction complications of therapeutic transcatheter embolization. Am. J. Surg. 139: 272–277, 1980PubMedCrossRefGoogle Scholar
  24. 24.
    Fisher, K.A., Mahajan, S.K., Hill, J.L., Stuart, F.P., Katz, A.I.: Prediction of azathioprine intolerance in transplant patients. Lancet 1: 828–830, 1976PubMedCrossRefGoogle Scholar
  25. 25.
    Owman, T., Lunderquist, A., Alwmark, A., Borjesson, B.: Embolization of the spleen for the treatment of splenomegaly and hypersplenism in patients with portal hypertension. Invest. Radiol. 14: 457–464, 1979PubMedCrossRefGoogle Scholar
  26. 26.
    Maddison, F.: Embolic therapy of hypersplenism. Invest. Radiol. 8: 280–281, 1973CrossRefGoogle Scholar
  27. 27.
    Guildord, W.B., Scatliff, J.H.: Transcatheter embolization of the spleen for control of splenic hemorrhage and in situ splenectomy: An experimental study using silicone spheres. Radiology 119: 549–553, 1976Google Scholar
  28. 28.
    Goldman, M.L., Skorapa, V., Galambos, J.T., Oenkt, X., Jove, D.F., Silberman, M.: Intraarterial tissue adhesives for medical splenectomy in dogs. Am. J. Gastroenterol. 70: 489–495, 1978PubMedGoogle Scholar
  29. 29.
    Anderson, J.H., Buban, A., Wallace, S., Hester, J.P., Burke, J.S.: Transcatheter splenic arterial occlusion: An experimental study in dogs. Radiology 125: 95–102, 1977PubMedGoogle Scholar
  30. 30.
    Levy, J.M., Wasserman, P., Pitha, N.: Presplenectomy transcatheter occlusion of the splenic artery. Arch. Surg. 114: 198–199, 1979PubMedCrossRefGoogle Scholar
  31. 31.
    Philipps, J.F.: Transcatheter electrocoagulation of blood vessels. Invest. Radiol. 8: 295–304, 1973CrossRefGoogle Scholar
  32. 32.
    Ariel, I.M., Padula, G. Irradiation of the spleen by the intraarterial administration of yttrium-90 microspheres in patients with malignant lymphoma. Cancer 31: 90–96, 1973PubMedCrossRefGoogle Scholar
  33. 33.
    Bergin, J.J., Zuck, T.F., Mulder, R.E.: Compelling splenectomy in medically compromised patients. Ann. Surg. 178: 761–768, 1973PubMedCrossRefGoogle Scholar
  34. 34.
    Chuang, V.P., Reuter, S.R.: Selective arterial embolization for the control of traumatic splenic bleeding. Invest. Radiol. 10: 18–24, 1975PubMedCrossRefGoogle Scholar
  35. 35.
    Chuang, V.P., Reuter, S.R.: Experimental diminution of splenic function by selective embolization of the splenic artery. Surg. Gynecol. Obstet. 140: 715–720, 1975PubMedGoogle Scholar
  36. 36.
    Bucheler, E., Thalen, M., Schirmer, G., Schulz, D., Fromm-hold, H., Siedeck, M., Kaufer, C: Katheterembolisation der Milzarterien zum Stopp der akuten Varizenblutung. Fortschr. Röntgenstr. 1220: 224–229, 1975CrossRefGoogle Scholar
  37. 37.
    Papadimitriou, J., Tritakis, C, Karatzas, G., Papaioannou, A.: Treatment of hypersplenism by embolus placement in the splenic artery. Lancet 2: 1268–1269, 1976PubMedCrossRefGoogle Scholar
  38. 38.
    Mozes, M., Spigos, D., Jonasson, O., Thomas, P.: Transcatheter partial splenic embolization for azathioprine intolerance in renal transplant recipients. Transplant. Proceed. 11: 45–48, 1979Google Scholar
  39. 39.
    Spigos, D.G., Jonasson, O., Mozes, M., Capek, V.: Partial splenic embolization in the treatment of hyperplenism. Am. J. Roentgenol. 132: 777–782, 1979Google Scholar
  40. 40.
    Rice, H.M., James, P.D.: Ectopic splenic tissue: Failed to prevent fatal pneumococcal septicaemia after splenectomy for trauma. Lancet 1: 565–566, 1980PubMedCrossRefGoogle Scholar
  41. 41.
    Van Wyck, D.B., Witte, M.H., Witte, C.L., Thies, A.C.: Critical splenic mass for survival from experimental pneumococce-mia. J. Surg. Res. 28: 14–17, 1980PubMedCrossRefGoogle Scholar
  42. 42.
    Coil, J.A., Dickerman, J.P., Horner, S.R., Chalmer, B.J.: Pulmonary infection in splenectomized mice: Protection by splenic remnant. J. Surg. Res. 28: 18–22, 1980PubMedCrossRefGoogle Scholar
  43. 43.
    Pringle, K.C., Rowley, D.M., Burrington, J.D.: Immunological response in splenectomized and partially splenectomized rats. J. Ped. Surg. (in press)Google Scholar
  44. 44.
    Pearson, H.A., Johnston, D., Smith, K.A., Touloukian, R.J.: The born-again spleen: Return of splenic function after splenectomy for trauma. N. Engl. J. Med. 298: 1389–1392, 1978PubMedCrossRefGoogle Scholar
  45. 45.
    Gopal, V., Bisno, A.L.: Fulminant pneumococcal infection in “normal asplenic hosts.” Arch. Intern. Med. 137: 1526–1530Google Scholar
  46. 46.
    Witte, C.L., Witte, M.H., Renert, W., O’Mara, R.E., Lilien, D.L.: Splenic artery ligation in selected patients with hepatic cirrhosis and in sprague Dawley rats. Surg. Gynecol. Obstet. 142: 1–12, 1976PubMedGoogle Scholar
  47. 47.
    Tsapogas, J.J., Peabody, R.A., Karmody, A.M., Chuntrasakul, C, Goussous, H., Eckert, C: Patho-physiological changes following ischemia of the spleen. Ann. Surg. 178: 179–185, 1973PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1981

Authors and Affiliations

  • Demetrios G. Spigos
    • 1
  • Walter S. Tan
    • 1
  • Martin F. Mozes
    • 2
  • Kevin Pringle
    • 2
  • Ioulios Iossifides
    • 3
  • A. Benedict Cosimi
    • 4
  1. 1.Departments of RadiologyUniversity of Illinois HospitalChicagoUSA
  2. 2.Departments of SurgeryUniversity of Illinois HospitalChicagoUSA
  3. 3.Departments of PathologyUniversity of Illinois HospitalChicagoUSA
  4. 4.Department of SurgeryHarvard Medical School and Massachusetts General HospitalBostonUSA

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