Splenic artery embolisation for the emergency treatment of sinistral portal hypertension: a systematic review
File(s)
Published version
Author(s)
Grout-Smith, Harriet
Dumenci, Ozbil
Tait, N Paul
Alsafi, Ali
Type
Journal Article
Abstract
Objectives Sinistral portal hypertension (SPH) is caused by increased pressure on the left portal system secondary to splenic vein stenosis or occlusion and may lead to gastric varices. The definitive management of SPH is splenectomy, but this is associated with significant mortality and morbidity in the acute setting. In this systematic review, we investigated the efficacy and safety of splenic artery embolisation (SAE) in managing refractory variceal bleeding in patients with SPH.
Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies.
Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities.
Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.
Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies.
Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities.
Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.
Date Issued
2021-08
Date Acceptance
2021-06-01
Citation
Journal of Clinical Interventional Radiology ISVIR, 2021, 5 (02), pp.079-085
ISSN
2457-0214
Publisher
Georg Thieme Verlag KG
Start Page
079
End Page
085
Journal / Book Title
Journal of Clinical Interventional Radiology ISVIR
Volume
5
Issue
02
Copyright Statement
© 2021. Indian Society of Vascular and Interventional Radiology.
This is an open access article published by Thieme under the terms of the Creative
Commons Attribution-NonDerivative-NonCommercial-License, permitting copying
and reproduction so long as the original work is given appropriate credit. Contents
may not be used for commercial purposes, or adapted, remixed, transformed or
built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
This is an open access article published by Thieme under the terms of the Creative
Commons Attribution-NonDerivative-NonCommercial-License, permitting copying
and reproduction so long as the original work is given appropriate credit. Contents
may not be used for commercial purposes, or adapted, remixed, transformed or
built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Identifier
https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0041-1730876
Publication Status
Published
Date Publish Online
2021-06-30