Severe complications from partial splenic embolization in patients with liver failure

Area of Science:

• Interventional Radiology
• Hepatology
• Surgical Oncology

Background:

• Transcatheter splenic artery embolization is an emerging non-surgical treatment for hypersplenism.
• Previous studies suggested a fractionated approach with partial peripheral embolization yielded good results.
• This technique is often considered for patients with hypersplenism secondary to severe liver disease.

Observation:

• A recent case series involved three patients with severe liver disease and hypersplenism undergoing splenic artery embolization.
• Despite positive hematological responses, all three patients experienced grave complications.
• Complications included sepsis, pneumonia, abscess formation, and progressive liver failure, leading to death within six weeks.

Findings:

• The fractionated transcatheter embolization approach, while showing hematological improvement, resulted in fatal outcomes in this cohort.
• Severe liver disease appears to be a critical factor predisposing patients to life-threatening complications post-embolization.
• The observed complications underscore the significant risks associated with this procedure in a fragile patient population.

Implications:

• Transcatheter embolization of the spleen in patients with severe liver disease carries a high risk of mortality.
• Definitive surgical splenectomy should be considered as a subsequent treatment option once coagulation parameters normalize post-embolization.
• Further research is needed to identify safer treatment strategies for hypersplenism in patients with advanced liver disease.