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Partial splenic embolization in five children with hypersplenism: effects of reduced-volume embolization on efficacy
R K Harned1, H R Thompson, D A Kumpe
1Department of Radiology, University of Colorado Health Sciences Center, Denver, USA.
Insights
Reducing spleen volume during partial splenic embolization (PSE) for pediatric hypersplenism significantly lowers hospital stays and fever duration. This less invasive approach improves blood counts and reduces bleeding complications, offering a safer treatment option.
Area of Science:
- Interventional Radiology
- Pediatric Gastroenterology
- Hematology
Background:
- Hypersplenism in children can lead to significant morbidity, including cytopenias and bleeding.
- Partial splenic embolization (PSE) is an established treatment, but the optimal volume of splenic infarction is debated.
- Previous studies often involved extensive splenic infarction, potentially leading to higher complication rates.
Purpose of the Study:
- To evaluate the clinical outcomes of a reduced-volume partial splenic embolization (PSE) technique.
- To compare the safety and efficacy of embolizing 30%-40% of splenic volume versus 70%-80% in children with hypersplenism.
Main Methods:
- A prospective study of five children with hypersplenism undergoing 30%-40% splenic volume embolization.
- Comparison of outcomes with a retrospective cohort of 17 children who underwent 70%-80% PSE.
Main Results:
- Reduced-volume PSE significantly decreased hospital stay (6.6 vs. 16.0 days) and febrile period (5.0 vs. 15.0 days).
- Patients showed improved peak white blood cell counts (8,300 vs. 19,400/mm³) and platelet counts (153,000 vs. 636,000/mm³ peak).
- Follow-up demonstrated sustained platelet counts above baseline, reduced variceal hemorrhage (0.5 vs. 3.5 episodes/year), and decreased epistaxis (15 vs. 30 episodes/month).
Conclusions:
- Reduced-volume PSE is a safe and effective treatment for pediatric hypersplenism.
- This approach leads to decreased morbidity and sustained hematological improvement.
- No patients required repeat embolization, indicating the durability of the reduced-volume technique.
Purpose:
To evaluate the effects of reducing the volume of spleen infarcted during partial splenic embolization (PSE) for treatment of hypersplenism in children.
Materials And Methods:
Five children with hypersplenism underwent embolization of 30%-40% of the splenic volume. The results were compared with those of a previous study of 70%-80% PSE performed in 17 children.
Results:
The hospital stay after the procedure was reduced from 16.0 days +/- 8.0 to 6.6 days +/- 5.6. The febrile period decreased from 15.0 days +/- 8.1 to 5.0 days +/- 6.6. The peak white blood cell count was 8,300/mm3 +/- 4,600 (8.3 x 10(9)/L +/- 4.6) versus 19,400/mm3 +/- 7,800 (19.4 x 10(9)/L +/- 7.8) in the earlier study. The peak platelet count was 153,000/mm3 +/- 65,000 (153 x 10(9)/L +/- 65) versus 636,000/mm3 +/- 406,000 (636 x 10(9)/L +/- 406). The platelet count after a mean follow-up of 14 months was 70,000/mm3 +/- 7,000 (70 x 10(9)/L +/- 7) versus 230,000/mm3 +/- 62,000 (230 x 10(9)/L +/- 62) after a mean follow-up of 45 months. The frequency of variceal hemorrhage decreased from 3.5 to 0.5 episodes per year. The frequency of epistaxis decreased from 30 to 15 episodes per month.
Conclusion:
Reduced-volume embolization decreased morbidity. All patients maintained a platelet count above baseline, and no patient required repeat embolization.
