Partial splenic embolization as a rescue and emergency treatment for portal hypertension and gastroesophageal variceal hemorrhage

Table 2 Indications for partial splenic embolization (PSE)

	cirrhotic PH, n = 12	non-cirrhotic PH, n = 13	all patients, n = 25
PSE indications: n (%)
Persistent EVH	4 (33.3%)	3 (23.1%)	7 (28.0%)
Persistent GVH	2 (16.7%)	4 (30.8%)	6 (24.0%)
Recurrent EVH	1 (8.3%)	1 (7,7%)	2 (8%)
Recurrent GVH	0 (0.0%)	0 (0.0%)	0 (0.0%)
Controlled EVH with high risk of recurrent bleeding	4 (33.3%)	4 (30.8%)	8 (32.0%)
Controlled GVH with high risk of rebleeding	0 (0.0%)	1 (7.7%)	1 (4.0%)
Recurrent portal hypertensive gastropathy bleeding	1 (8.3%)	0 (0.0%)	1 (4.0%)
NSBB failure: n (%)	10 (83.3%)	11 (84.6%)	21 (84.0%)
TIPS contraindications: n (%)
TIPS anatomically not possible	4 (33.3)	9 (69.2)	13 (52.0)
Bilirubin > 5 mg/dl	3 (25.0)	0 (0.0)	3 (12.0)
TIPS not reasonable due to portal hemodynamics	2 (16.7)	4 (30.8)	6 (24.0)
TIPS failure with recurrent variceal bleeding	2 (16.7)	0 (0.0)	2 (8.0)
Right heart failure	1 (8.4)	0 (0.0)	1 (4.0)

Presentation of indications for partial splenic embolization (PSE), failure of nonspecific beta-blockers (NSBB), and contraindications for transjugular intrahepatic portosystemic shunt (TIPS) for cirrhotic and non-cirrhotic portal hypertension (PH). Classification of esophageal variceal hemorrhage (EVH) and gastric variceal hemorrhage (GVH) according to the ESGE Guideline on endoscopic diagnosis and management of esophagogastric variceal hemorrhage (2022). Persistent EVH and GVH were defined as emergency variceal hemorrhage. Contraindications for TIPS are presented according to the EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis (2018) and EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis (2022)

ISSN: 1471-230X