[Splenic artery embolization in hematologic diseases in children]

In the past four years or so splenectomy used in children with hematological defects, who showed hypersplenism has been replaced with partial arterial splenic embolization (Pase), in general, 2/3 of the lower spleen were embolized. Pase was performed after the selective catheterization of the splenic artery up to the hilum with local anesthesia. As an embolizing agent, with the first 2 patients a suspension of Gelaspon microparticles and absolute alcohol (90 degrees) was used, and with the others (7 patients with 9 embolizations) only absolute alcohol. The Pase indication was: congenital hemolytic anemia in 5 cases; thrombocytopenia in 3 cases (5 pase); portal hypertension by extra-hepatic blockage with secondary hypersplenism in one case where the endoscopic sclerosis of the esophageal varices had been done first, followed by Pase after weeks. The evolution after Pase was simple in 6 patients: fever, pain in the left hypochondrium, and moderate ileus for 2-3 days. In 3 cases the evolution was both complicated and difficult excessive Pase in the first 2 patients, that practically resulted in total splenectomy, and, in the other one, the growth of a big subcapsular hematoma with effusion that had to be eliminated through transparietal drainage, under echographic control and operated secondary for peritonitis. Hematologically, in all cases but one (1 failure) hypersplenism remission was obtained and the results are the same 1-3 years after Pase. Partial arterial splenic embolization can very well replace splenectomy in hematological defects manifested as hypersplenism. The use of absolute alcohol (90 degrees) as an excellent embolization agent has not been reported so far in children.