Spleen Embolization

Introduction:

The spleen plays a crucial role in the body's immune system, producing antibodies, monocytes, and activated lymphocytes. It is richly supplied with blood vessels and frequently damaged in blunt abdominal trauma, making it the most commonly affected internal organ. Splenic artery embolization is a supplementary procedure in the nonsurgical management of blunt splenic injuries. Splenectomy, the surgical removal of the spleen, has been associated with a heightened vulnerability to infections. As a result, splenic preservation treatments have been implemented to address this issue. Splenic artery embolization is currently considered the preferred treatment in the majority of trauma centers for managing splenic trauma without surgery.

What Is Spleen Embolization?

Splenic artery embolization is an endovascular procedure used to treat spleen and splenic artery conditions. It serves as an alternative to splenic artery ligation (an uncomplicated surgical treatment aimed at reducing splenic flow and portal circulation pressure in individuals diagnosed with liver damage) or splenectomy (a surgical intervention aimed at extracting the spleen from the body). It frequently leads to effective treatment of the underlying disease while preserving some degree of spleen function.

What Are the Causes of the Condition?

• Severe Injuries: Severe injuries to the spleen, namely those classified as AAST grade III-V, in individuals who are stable in terms of their blood circulation.

• Hypersplenism: Hypersplenism occurs when the spleen exhibits excessive activity, leading to the excessive removal of blood cells. It can lead to the development of anemia and can be attributed to conditions such as liver disorders, infections, and cancer.

• Splenic Malignancy: Splenic malignancy refers to cancerous cells in the spleen.

• Splenic Steal Syndrome: Splenic steal syndrome is a medical condition that redirects blood flow away from the spleen.

• Splenic Artery Aneurysm: A splenic artery aneurysm refers to a protruding and weakening segment of the artery responsible for supplying blood to the spleen, as well as some areas of the pancreas and stomach. While some individuals may not have any symptoms, a prevalent indication is pain in the upper left quadrant of the abdomen. Pregnancy and portal hypertension are both risk factors for the development and rupture of an aneurysm.

What Are the Complications of the Condition?

The complications of splenic artery embolization in individuals include a smaller proportion of patients experiencing major difficulties, while a substantial number experienced minor complications, with some overlap between the two.

• Persistent bleeding was the most prevalent severe consequence. Incidence of splenic infarct, which did not necessitate any intervention, was observed in a portion of patients, subsequently leading to the development of a splenic abscess.

• Proximal splenic artery embolization is linked to a lower occurrence and smaller splenic infarct sizes than distal embolization.

• Following partial splenic embolization, the majority of patients experience postembolization syndrome, characterized by symptoms such as fever, nausea, and pain in the left upper quadrant. Splenic embolizations targeting the lower and mid-pole reduce the incidence of atelectasis (pulmonary collapse refers to the condition where a lung or a section of a lung, commonly referred to as a lobe, collapses. It occurs when the little air sacs in the lungs, known as alveoli, experience a loss of air) and pneumonia.

• Following splenic embolization, notable problems included abscess formation, a substantial buildup of fluid in the pleural cavity leading to difficulty breathing, fluid accumulation in the abdomen, pneumonia, blood clots in the lungs, blood clots in the portal vein, and liver failure.

What Are the Outcomes?

Splenic trauma is characterized by a direct and forceful impact resulting in injury to the spleen.

Preserving the spleen is crucial due to a one to two percent chance of sepsis occurring during a person's lifetime after undergoing splenectomy.

For the Use of Splenic Artery Embolization in Nonoperative Management.

• Arterial embolization is a surgical procedure that involves the obstruction of the blood supply to a tumor or an abnormal tissue.

• The location has been increasingly used to manage splenic damage without surgery, decreasing death rates and reducing the average length of hospital stay.

• Additionally, it was determined that splenic artery embolization greatly enhanced the probability of preserving the spleen.

Nontraumatic Partial Splenic Embolization

• Partial splenic embolization is a therapeutic procedure employed to enhance platelet levels in patients suffering from hypersplenism due to idiopathic thrombocytopenic purpura (a blood disorder that is distinguished by an abnormal reduction in the number of platelets in the blood.), thalassemia (a diverse group of blood diseases that affect the hemoglobin genes and make the maturation process less effective.), idiopathic hypersplenism(this is a disease where reticuloendothelial enlargement in the spleen makes it more difficult for the organ to break down normal blood components.), and cytopenia (low quantities of red blood cells, white blood cells, or platelets are present.) induced by anticancer chemotherapy.

• Splenic embolization is a procedure employed in patients suffering from portal hypertension to enhance liver function, reduce variceal bleeding, address hepatic encephalopathy (a neurological disorder that arises from advanced liver disease), and increase blood counts.

• Improves liver function in people with cirrhosis. This enhancement can be mostly attributed to better blood circulation in the hepatic artery and superior mesenteric regions. Partial splenic embolization is an effective method for reducing variceal hemorrhage. The concurrent use of splenic embolization and variceal ligation decreased the rebleeding rate. The annual bleeding events fell from 2.4 to 0.48 following partial splenic embolization.

• Partial splenic embolization additionally enhances blood counts. Platelet count rises 12 to 24 hours after partial splenic embolization and reaches its highest point within one to two weeks. After approximately two months, the count often stabilizes at almost twice as high as the amount before embolization. It gradually decreases during the subsequent years. The red blood cell count substantially increases within six months following embolization and remains elevated for a prolonged duration.

What Is the Follow-up of the Condition?

After splenic artery embolization, the patient must be closely monitored and examined clinically and through imaging techniques. A contrast-enhanced CT scan should be conducted on the fifth day after the intervention. Possible complications of severe splenic infarction include inflammatory pancreatitis or embolization in areas other than the intended target. Nevertheless, it is crucial to closely observe the patient for potential pseudoaneurysm formation or secondary splenic rupture. The use of vaccines to prevent overwhelming post-splenectomy infection is a topic of debate.

Conclusion

Splenic artery embolization is a procedure that helps in the nonoperative treatment of splenic injuries. Regardless of whether the embolization technique used is proximal or distal, splenic artery embolization efficiently achieves both hemorrhage control and preservation of splenic function. The effectiveness of the operation relies on the collaboration between the trauma surgeon and the interventional radiologist to accurately choose the appropriate patients. Partial splenic embolization is a highly effective surgery for treating hypersplenism and relieving pressure on gastroesophageal varices. Partial splenic embolization can be safely conducted within 50 to 70 percent of the total volume, provided antibiotics are given before and during the treatment. Embolization can be conducted independently or in combination with other techniques.