Partial splenic artery embolization in cirrhotic patients

Table 1 Study demographics and outcomes of partial splenic embolization

Ref.	Year	Country	Study type	Number of Pts	Length of follow-up	Mean ± SD, platelet count prior to PSE inK/μL	Mean ± SD, WBC count prior to PSE in K/μL	Indication for PSE	Extent of spleen targeted	Mean ± SD, platelet count at 2 wk in K/μL	Mean ± SD, platelet count at 1 mo in K/μL	Mean ± SD, platelet count at 1 yr in K/μL	Mean ± SD, WBC count at 2 wk in	Mean ± SD, WBC count at 1 mo in K/μL	Mean ± SD, WBC count at 1 yr in K/μL
Kim et al[11]	2012	South Korea	Case series report	11	6-28 mo	Not provided	Not provided	All patients S/P OLT; 6/11 w/thrombocytopenia, 5/11 w/refractory ascites	70%-80%	Not provided	Not provided	Not provided	Not provided	Not provided	Not provided
Elmonem et al[12]	2010	Egypt	Case series report	23	2 yr	41.3 ± 13.0	2.3 ± 0.47	Hypersplenism in Cirrhosis w/leukopenia and thrombocytopenia, no HCC, and no SBP	50%-70%	124.3 ± 23.9	115.8 ± 18.4	94.1 ± 12.9	8.26 ± 1.54	6.53 ± 1.74	4.62 ± 1.13
Zhu et al[14]	2009	China	Nonrandomized prospective trial	Total 62 Group A: 12 Group B: 34 Group C: 16	5 yr	Group A: 40.2 ± 13.0 Group B: 37.4 ± 12.3 Group C: 43.6 ± 11.7	Group A: 2.42 ± 0.44 Group B: 2.54 ± 0.57 Group C: 2.64 ± 0.4	Hypersplenism in Cirrhosis, w/thrombocytopenia or neutropenia. No SBP, no Severe Jaundice	50%-70%	Group A: 1701 Group B: 1301 Group C: 801	Group A: 1301 Group B: 1101 Group C: 701	Group A: 1001 Group B: 901 Group C: 501	Group A: 7.51 Group B: 6.51 Group C: 4.01	Group A: 6.01 Group B: 5.51 Group C: 3.71	Group A: 4.51 Group B: 4.01 Group C: 3.01
Amin et al[9]	2009	Egypt	Randomized control trial	Total 40 PSE: 20 SPL: 20	6 mo	PSE: 39.7 ± 9.7 SPL: 47.2 ± 10.3	PSE: 3.3 ± 0.7 SPL: 2.8 ± 1.1	Cirrhosis w/o bone marrow disease, ischemic heart disease, renal failure, malignancy, or medical unstability	50%	PSE: 211.5 ± 36.2 SPL: 240.7 ± 52.0	Not provided	Not provided	PSE: 12.6 ± 2.6 SPL: 7.7 ± 1.9	Not provided	Not provided
Zhu et al[16]	2008	China	Randomized control trial	Total 60 GF: 32 PVA: 28	3 yr	GF: 47.06 ± 14.85 PVA: 44.36 ± 16.67	GF: 2.62 ± 0.67 PVA: 2.57 ± 0.63	Hypersplenism in cirrhosis w/thrombocytopenia or neutropenia. No SBP, no HCC, no hyperbilirubinemia	50%-70%	GF: 135.4 ± 28.1 PVA: 153.4 ± 37.1	GF: 113.2 ± 17.6 PVA: 125.4 ± 23.3	GF: 95.8 ± 13.9 PVA: 106.2 ± 17.2	GF: 6.6 ± 1.5 PVA: 7.5 ± 1.7	GF: 5.1 ± 0.9 PVA: 5.7 ± 1.2	GF: 4.2 ± 0.6 PVA: 4.7 ± 1.0
Hayashi et al[17]	2007	Japan	Nonrandomized prospective trial	42	1 yr	45 ± 11.7	2.9 ± 1.0	Thrombocytopenia caused by hypersplenism due to cirrhosis	70%-80%	Not provided	116 ± 51	103 ± 34	Not provided	Not provided	Not provided
Lee et al[15]	2007	China	Nonrandomized prospective trial	10	1 yr	56 ± 8.0	Not provided	Thrombocytopenia in setting of cirrhosis	20%-40%	192	Not provided	145	Not provided	Not provided	Not provided
N'Kontchou et al[13]	2005	France	Retrospective review	32	1-87 mo	48 ± 14	4.2 ± 1.6	Cirrhosis w/severe cytopenia/leukopenia preventing treatment or severe purpur, or painful splenomegaly	50%	Not provided	137.5 ± 77.4	Not provided	Not provided	6.5 ± 2.9	Not provided

¹Data From Zhu et al[14,16] was extracted from a graph without exact values, values used are the authors closest approximations. PSE: Partial splenic artery embolization; SPL: Splenectomy; GF: Gel foam; PVA: Polyvinyl alcohol.

Table 2 Complications in partial splenic artery embolization

Ref.	Year	Country	Study type	Complication: Frequency of post embolization syndrome	Complication: Mean length of post embolization syndrome-Days	Major complications: Total number	Persistant thrombocytopenia	Splenomegaly	Pleural effusion/ascites	Variceal bleeding	Portal vein thrombosis	Bacterial peritonitis	Splenic abscess	PSE-related death	Repeat embolization required
Kim et al[11]	2012	South Korea	Case series report	100.00%	Not provided	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%
Elmonem et al[12]	2010	Egypt	Case series report	91.30%	Not provided	34.80%	4.30%	4.30%	8.70%	0.00%	4.30%	4.30%	4.30%	4.30%	4.30%
Zhu et al[14]	2009	China	Nonrandomized prospective trial	Total 85.5% Group A: 100% Group B: 91.2% Group C: 62.5%	Group A: 13 Group B: 7 Group C: 3	Total 14.5% Group A: 50% Group B: 8.8% Group C: 0%	Total 0% Group A: 0% Group B: 0% Group C: 0%	Total 0% Group A: 0% Group B: 0% Group C: 0%	Total 4.8% Group A: 16.6% Group B: 2.9% Group C: 0%	Total 1.6% Group A: 8.3% Group B: 0% Group C: 0%	Total 1.6% Group A: 8.3% Group B: 0% Group C: 0%	Total 1.6% Group A: 8.3% Group B: 2.9% Group C: 0%	Total 1.6% Group A: 8.3% Group B: 0% Group C: 0%	Total 1.6% Group A: 8.3% Group B: 0% Group C: 0%	Total 0% Group A: 0% Group B: 0% Group C: 0%
Amin et al[9]	2009	Egypt	Randomized control trial	Not provided	PSE: 2.1 (0.4) SPL: 4.3 (1.1)	PSE: 25% SPL: 25%	PSE: 0% SPL: 0%	PSE: 0% SPL: 0%	PSE: 10% SPL: 10%	PSE: 0% SPL: 0%	PSE: 5% SPL: 15%	PSE: 0% SPL: 0%	PSE: 5% SPL: 0%	PSE: 5% SPL: 0%	PSE: 0% SPL: 0%
Zhu et al[16]	2008	China	Randomized control trial	GF: 90.6% PVA: 100%	GF: 6.4 (3.6) PVA: 7.6 (2.8)	GF: 25.0% PVA: 21.4%	GF: 0% PVA: 0%	GF: 0% PVA: 0%	GF: 9.4% PVA: 10.7%	GF: 3.1% PVA: 3.6%	GF: 3.1% PVA: 7.1%	GF: 6.3% PVA: 0%	GF: 3.1% PVA: 0%	GF: 3.1% PVA: 0%	GF: 0% PVA: 0%
Hayashi et al[17]	2007	Japan	Nonrandomized prospective trial	100.00%	Not provided	11.90%	0.00%	0.00%	9.50%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%
Lee et al[15]	2007	China	Nonrandomized prospective trial	100.00%	Not provided	10.00%	0.00%	0.00%	10.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%
N'Kontchou et al[13]	2005	France	Retrospective review	78.10%	14	28.10%	3.10%	0.00%	6.30%	0.00%	6.30%	0.00%	6.30%	6.3%1	3.10%

¹Both deaths in the trial were in patients with > 70% splenic embolization. PSE: Partial splenic artery embolization; SPL: Splenectomy; GF: Gel foam; PVA: Polyvinyl alcohol.