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Transsplenic splenoportography and portal venous interventions in pediatric patients

Eric J Monroe1, Ethan J Speir2, C Matthew Hawkins2,3

  • 1Department of Radiology, Division of Interventional Radiology, Seattle Children's Hospital and University of Washington, 4800 Sand Point Way NE, M/S R-5417, Seattle, WA, 98105, USA. eric.monroe@seattlechildrens.org.

Pediatric Radiology
|May 15, 2018
PubMed

Insights

Transsplenic portal venous access is safe and effective for pediatric diagnostic imaging and interventions when other methods fail. Minimizing access size reduces bleeding risks, making this approach valuable for complex cases.

Area of Science:

  • Pediatric Interventional Radiology
  • Hepatobiliary Surgery
  • Vascular Access Techniques

Background:

  • Limited data exists on transsplenic portal venous access in children.
  • Concerns about bleeding risks have led to underutilization of this technique.
  • Transsplenic access may be crucial for specific diagnostic and interventional procedures.

Purpose of the Study:

  • To evaluate the safety and efficacy of transsplenic splenoportography in children.
  • To assess the utility of transsplenic portal venous interventions in pediatric patients.
  • To determine the factors influencing the success and complications of transsplenic access.

Main Methods:

  • Retrospective review of pediatric patients undergoing percutaneous transsplenic portal venous access.
  • Analysis of procedural indications, imaging, technical details, and clinical outcomes.
  • Data collected from two tertiary pediatric institutions between 2012 and 2017.

Main Results:

  • Transsplenic portal venous access was successful in all cases.
  • Diagnostic splenoportography achieved 100% success in providing necessary information.
  • Four complex portal interventions, including angioplasty and thrombectomy, were 100% successful.
  • Intraperitoneal bleeding occurred in 7.7% of cases, with transfusion needed in 3.8%.
  • No hemorrhage was observed with 4 Fr or smaller access tracts.

Conclusions:

  • Transsplenic splenoportography is safe and effective for pediatric patients when noninvasive imaging is insufficient.
  • The transsplenic approach offers advantages for complex portal venous interventions.
  • Bleeding risk is associated with access tract size and can be managed with embolization.
Abstract

Keywords:
ChildrenInterventional radiologyPortal hypertensionPortal veinSpleenSplenoportographyTranssplenic

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