Partial splenic embolization in patients with cirrhosis: Comparison of < 50% versus > 50% infarction strategy

Splenomegaly commonly occurs in portal hypertension due to cirrhosis, potentially causing leukopenia, thrombocytopenia and portal hypertension. Partial splenic artery embolization (PSE) serves as a substitute for splenectomy, given the significant risks associated with surgery in cirrhotic patients. In addition to improving hematologic indices, PSE may indirectly benefit liver-related outcomes and reduce portal hypertension complications.

The objective of this study was to assess the short-term (One-month) and long-term (24-month) impact on hematological parameters and liver function post-PSE, to compare the hematological parameters and liver function in patients with different volumes of spleen embolization (group A-< 50% and group B-> 50%) and to evaluate the changes in the status of esophageal varices and Child-Turcotte-Pugh (CTP) score after PSE. A review of medical records of 47 patients who underwent PSE between March 2011 and March 2023 was conducted from the hospital database. PSE was primarily indicated for hypersplenism-related complications in cirrhotic patients and to improve blood counts for safer anti-viral therapy in hepatitis C virus (HCV) infection. Information regarding patient demographics, underlying liver disease, indication for PSE and baseline laboratory values was noted at short-term (One month) and long-term duration (24 months).

Short-term follow-up revealed an 80 ± 11.8% increase in total leukocyte count (TLC) and a 143 ± 39% rise in platelet count, while long-term follow-up showed a 56 ± 8.6% increase in TLC and an 83.7 ± 21% increase in platelet count. Albumin levels rose from 3.0 ± 0.6 g/dL before PSE to 3.3 ± 0.58 g/dL (10.4 ± 1.4% increase) in the long term. Cumulative variceal bleeding episodes decreased from 2.1 to 0.72, alongside an improved CTP score from baseline.

PSE leads to sustained hematologic improvement and favorable changes in liver-related parameters. Embolization limited to < 50% achieves comparable long-term benefits with fewer complications, supporting its role as a safer therapeutic strategy in cirrhotic patients with hypersplenism.