[Percutaneous subtotal splenic embolization in thalassemia major. A 4-year follow up]

Ten young patients affected with thalassemia major with hypersplenism were treated with subtotal percutaneous embolization. Percutaneous procedure was used to correct hypersplenism, while preserving a small portion of splenic parenchyma. Embolization was successful in 9 patients, and no significant complications were observed; in 1 patient arterial catheterization and splenic embolization were not possible due to splenic artery tortuosity. Post-procedural clinical course was characterized by intense pain, not always reduced by therapy. Hospitalization time was similar to that of surgical splenectomy. Effectiveness of percutaneous embolization was evaluated with splenic scintigraphy, clearance of erythrocytes marked with 99mTc and denatured with BMHP and with the analysis, both before and after percutaneous procedure, of the following 3 parameters: annual blood consumption, behavior of pre-transfusional hemoglobin, and transfusional pause. Six patients underwent a 4-year follow-up. In all cases scintigraphy showed the effectiveness of subtotal embolization, and clearance of erythrocytes appeared slower than before. As for clinics, an improvement was observed in transfusional parameters. The results from our series, though numerically limited, support the role of percutaneous splenic embolization as an alternative to surgical splenectomy in high risk patients or in patients who refuse surgery.