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[Follow-up results of splenic artery embolization in liver cirrhosis]
Insights
Splenic artery embolization (SAE) and splenectomy offer no survival benefit over medical therapy for liver cirrhosis with hypersplenism. These interventions show high complication rates and limited long-term effectiveness, questioning their routine use.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Surgical Oncology
Background:
- Liver cirrhosis frequently leads to hypersplenism, a condition characterized by an enlarged spleen and decreased blood cell counts.
- Hypersplenism in liver cirrhosis can exacerbate cytopenias, impacting patient quality of life and prognosis.
- Current treatment options for hypersplenism in liver cirrhosis include medical management, splenectomy, and splenic artery embolization (SAE).
Purpose of the Study:
- To compare the long-term efficacy and safety of splenic artery embolization (SAE) versus surgical splenectomy and medical therapy.
- To evaluate the impact of these interventions on hypersplenism correction and patient survival in liver cirrhosis.
- To determine the optimal management strategy for hypersplenism in patients with liver cirrhosis.
Main Methods:
- A comparative study involving 50 patients undergoing SAE, 20 patients undergoing surgical splenectomy, and 46 patients receiving medical therapy.
- Assessment of lethality, complication rates, and long-term correction of hypersplenism.
- Analysis of clinical outcomes and survival rates across the treatment groups.
Main Results:
- SAE exhibited high lethality (18%) and complication rates (12%).
- Surgical splenectomy had lower lethality (10%) and complication rates (5%) compared to SAE.
- Long-term correction of hypersplenism was achieved in only 16% of patients following SAE, with no significant difference in survival or clinical outcomes between SAE, splenectomy, and medical therapy.
Conclusions:
- Splenic artery embolization is associated with significant complications and limited long-term effectiveness for hypersplenism in liver cirrhosis.
- Neither SAE nor splenectomy demonstrated improved survival compared to conservative medical management.
- Routine use of SAE and splenectomy for hypersplenism in liver cirrhosis is not recommended due to unfavorable risk-benefit profiles.
Abstract:
Long-term results of splenic artery embolization (SAE) were compared with those of surgical splenectomy and medical therapy for liver cirrhosis complicated by hypersplenism (50, 20 and 46 patients, respectively). Lethality and complication occurrence (AFTER) SAE were as high as 18% and 12% vs 10% and 5% after splenectomy. In long-term period correction of hypersplenism persisted only in 16%. However, clinical outcomes and survival of patients treated conservatively, did not significantly differ from results of transcatheter and surgical treatment. This investigation evidences that SAE has a high rate of complications and low effectiveness. Both SAE and splenectomy did not improve the survival if compared with medical therapy and therefore they should not be routinely used in clinical practice.