Long-term outcome of angiographic partial splenectomy in patients with decompensated liver cirrhosis and hypersplenism

Background and study aimsHypersplenism is one of the serious complications of splenomegaly complicating liver cirrhosis. Although partial splenic embolization has been proposed in patients with cirrhosis and thrombocytopenia, there are limited data on long-term outcome. The aim of our study was prospective evaluation of the long-term effects of angiographic partial splenectomy (APS) using polyvinyl alcohol (PVA) or gelfoam particles in patients with decompensated liver cirrhosis and hypersplenism.Patients and methodsThis study was done at Radiology and Tropical Medicine of Tanta University hospitals. Sixty patients were randomly assigned to two equal groups, PVA group, and gelfoam group. Control group included 18 patients, who refused invasive procedures and treated conservatively. Informed consent was obtained from every patient.ResultsAll groups were matched as regards age, sex, Child class, presence of oesophageal varices and complete blood count findings. APS was successfully performed in all 60 patients. Post-embolization syndrome was the most frequent side effect in both test groups while the need for repeated transfusions was significantly higher in the control group. No significant difference in mortality for all groups was detected. Variceal bleeding was significantly more in the control group. The procedure related complications were comparable in both test groups.All blood indices have significantly improved in comparison to the control group (p < 0.05). In both test groups white blood cells (WBCs), platelets (PLT) and haemoglobin improved significantly in comparison to the pre-procedure values (p < 0.05). Post-procedure WBCs and PLT were significantly higher in the gelfoam group than those in the PVA group (p < 0.05).ConclusionAPS is effective and has a favourable long-term outcome in the treatment of hypersplenism in Egyptian patients with decompensated post-hepatitis C cirrhosis. APS decreased the need for repeated transfusions. Both types of embolizing particles (PVA and gelfoam) were comparable as regards efficacy and post-procedure complications. APS may decrease the rate of variceal bleeding and future studies are needed to clarify its effects on portal hypertension.