Partial splenic embolization PSE, a minimally invasive intervention for hypersplenism, refers to a clinical syndrome accompanied by splenomegaly and excessive consumption of blood cells due to various causes.
Common causes.
1, stasis splenomegaly due to portal hypertension, is the most common type of hypersplenism, mostly secondary to various causes of cirrhosis (viral hepatitis, alcoholic liver injury, hepatic schistosomiasis or schistosomiasis, sick autoimmune hepatitis, Buga syndrome); portal vein thrombosis or cavernous vascular degeneration, etc.
2, chronic hemolytic diseases such as hereditary spherocytosis, autoimmune hemolysis and maritime anemia, etc.
Clinical manifestations.
1, the dominant effect of enlarged spleen, abdominal distension and feeling of fullness after eating are predominant.
2. Decreased white blood cells, which can easily cause infection, decreased red blood cells, i.e. anemia, which can be manifested by pallor and weakness, and decreased platelets, which can easily cause bleeding.
Hazards.
1, immune lowering, white blood cells are reduced after easy to cause infection.
2. Decreased platelets lead to decreased coagulation function, which is prone to bleeding (especially when platelets PLT <20X109/L, it is easy to induce spontaneous fatal esophageal and intracranial bleeding).
Interventional treatment of hypersplenism
Indications.
Patients with cirrhotic portal hypertension with hypersplenism, α-thalassemia, hereditary spherocytosis, hereditary elliptocytosis, idiopathic thrombocytopenic purpura (ITP) are the main indications; autoimmune hemolytic anemia, β+/β+ thalassemia, Hodgkin’s disease, chronic leukemia, Gaucher disease in which blood cells can be destroyed both in the spleen and in other organs. Splenic embolization can be used
Interventional treatment.
Partial splenic embolization PSE is currently used. The embolization material is mainly gelatin sponge particles or granular microspheres such as PVA, KMG microspheres, etc.
Fig1 Arteriogram shows a tortuous splenic artery. The parenchymal staining of the spleen was significantly enlarged
Fig2 Partial embolization of splenic artery by microcatheter superselection
Fig3 Partial stumping of splenic artery and partial loss of staining of splenic parenchyma seen after embolization
Effect.
Maddison first reported the successful application of partial splenic embolization PSE in 1973
Partial splenic embolization PSE was first reported by Maddison in 1973 for the treatment of thrombocytopenia and leukopenia due to hypersplenism. Today, this technique is widely used in clinical practice and has been shown to
The effectiveness of this technique in improving leukocyte and platelet counts has been widely recognized.