Splenic Artery Embolization for Nonocclusive Hepatic Artery Hypoperfusion

Abstract

Various minimally invasive, surgical, and laparoscopic interventions are performed for treatment and management of splenic artery steal syndrome in liver transplant and cirrhotic patients. Common approaches include splenic artery banding, ligation, stenting, and embolization to increase hepatic arterial flow. Splenic artery embolization has undergone further development to facilitate timely diagnosis, increase efficacy, decrease adverse outcomes, and improve patient selection. We review the current diagnostic modalities and technical advancements of splenic artery embolization to improve hepatic arterial perfusion in patients with splenic artery steal syndrome.

Keywords

splenic artery steal syndrome - liver transplant - cirrhotic patient - nonocclusive hepatic artery hypoperfusion

• References

• 1 Saad WE. Nonocclusive hepatic artery hypoperfusion syndrome (splenic steal syndrome) in liver transplant recipients. Semin Intervent Radiol 2012; 29 (02) 140-146
• 2 Nüssler NC, Settmacher U, Haase R, Stange B, Heise M, Neuhaus P. Diagnosis and treatment of arterial steal syndromes in liver transplant recipients. Liver Transpl 2003; 9 (06) 596-602
• 3 Geissler I, Lamesch P, Witzigmann H, Jost U, Hauss J, Fangmann J. Splenohepatic arterial steal syndrome in liver transplantation: clinical features and management. Transpl Int 2002; 15 (2-3): 139-141
• 4 Sevmis S, Boyvat F, Aytekin C. , et al. Arterial steal syndrome after orthotopic liver transplantation. Transplant Proc 2006; 38 (10) 3651-3655
• 5 Shimizu K, Tashiro H, Fudaba Y. , et al. Splenic artery steal syndrome in living donor liver transplantation: a case report. Transplant Proc 2007; 39 (10) 3519-3522
• 6 Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol 2014; 6 (05) 160-168
• 7 Meighani A, Jafri SM, Raoufi M, Salgia R. Splenic artery embolization for treatment of refractory ascites after liver transplantation. ACG Case Rep J 2016; 3 (02) 136-138
• 8 Langer R, Langer M, Scholz A, Felix R, Neuhaus P, Keck H. The splenic steal syndrome and the gastroduodenal steal syndrome in patients before and after liver transplantation [in German]. Aktuelle Radiol 1992; 2 (02) 55-58
• 9 De Carlis L, Sansalone CV, Rondinara GF. , et al. Splenic artery steal syndrome after orthotopic liver transplantation: diagnosis and treatment. Transplant Proc 1993; 25 (04) 2594-2596
• 10 Vogl TJ, Pegios W, Balzer JO, Lobo M, Neuhaus P. Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries [in German]. RoFo Fortschr Geb Rontgenstr Nuklearmed 2001; 173 (10) 908-913
• 11 Langer R, Langer M, Neuhaus P, Scholz A, Felix R. Angiographic diagnosis in liver transplantation. II: Angiography after transplantation [in German]. Digitale Bilddiagn 1990; 10 (3-4): 92-96
• 12 Quintini C, Hirose K, Hashimoto K. , et al. “Splenic artery steal syndrome” is a misnomer: the cause is portal hyperperfusion, not arterial siphon. Liver Transpl 2008; 14 (03) 374-379
• 13 Postema M, Gilja OH. Contrast-enhanced and targeted ultrasound. World J Gastroenterol 2011; 17 (01) 28-41
• 14 Zhu XS, Gao YH, Wang SS. , et al. Contrast-enhanced ultrasound diagnosis of splenic artery steal syndrome after orthotopic liver transplantation. Liver Transpl 2012; 18 (08) 966-971
• 15 Bárcena R, Moreno A, Foruny JR. , et al. Improved graft function in liver-transplanted patients after partial splenic embolization: reversal of splenic artery steal syndrome?. Clin Transplant 2006; 20 (04) 517-523
• 16 Grieser C, Denecke T, Steffen IG. , et al. Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation. Eur Radiol 2010; 20 (01) 108-117
• 17 Kirbas I, Ulu EM, Ozturk A. , et al. Multidetector computed tomographic angiography findings of splenic artery steal syndrome in liver transplantation. Transplant Proc 2007; 39 (04) 1178-1180
• 18 Sanyal R, Shah SN. Role of imaging in the management of splenic artery steal syndrome. J Ultrasound Med 2009; 28 (04) 471-477
• 19 Saad WE. Management of nonocclusive hepatic artery complications after liver transplantation. Tech Vasc Interv Radiol 2007; 10 (03) 221-232
• 20 Rasmussen A, Hjortrup A, Kirkegaard P. Intraoperative measurement of graft blood flow—a necessity in liver transplantation. Transpl Int 1997; 10 (01) 74-77
• 21 Uflacker R, Selby JB, Chavin K, Rogers J, Baliga P. Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation. Cardiovasc Intervent Radiol 2002; 25 (04) 300-306
• 22 Pinto S, Reddy SN, Horrow MM, Ortiz J. Splenic artery syndrome after orthotopic liver transplantation: a review. Int J Surg 2014; 12 (11) 1228-1234
• 23 Lima CX, Mandil A, Ulhoa AC, Lima AS. Splenic artery steal syndrome after liver transplantation: an alternative technique of embolization. Transplant Proc 2009; 41 (05) 1990-1993
• 24 Mogl MT, Nüssler NC, Presser SJ. , et al. Evolving experience with prevention and treatment of splenic artery syndrome after orthotopic liver transplantation. Transpl Int 2010; 23 (08) 831-841
• 25 Presser N, Quintini C, Tom C. , et al. Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients: a 5-year experience. Liver Transpl 2015; 21 (04) 435-441
• 26 Umeda Y, Yagi T, Sadamori H. , et al. Preoperative proximal splenic artery embolization: a safe and efficacious portal decompression technique that improves the outcome of live donor liver transplantation. Transpl Int 2007; 20 (11) 947-955
• 27 Zhu X, Tam MD, Pierce G. , et al. Utility of the Amplatzer vascular plug in splenic artery embolization: a comparison study with conventional coil technique. Cardiovasc Intervent Radiol 2011; 34 (03) 522-531
• 28 Widlus DM, Moeslein FM, Richard III HM. Evaluation of the Amplatzer vascular plug for proximal splenic artery embolization. J Vasc Interv Radiol 2008; 19 (05) 652-656
• 29 Schnüriger B, Inaba K, Konstantinidis A, Lustenberger T, Chan LS, Demetriades D. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma 2011; 70 (01) 252-260
• 30 Killeen KL, Shanmuganathan K, Boyd-Kranis R, Scalea TM, Mirvis SE. CT findings after embolization for blunt splenic trauma. J Vasc Interv Radiol 2001; 12 (02) 209-214
• 31 Koconis KG, Singh H, Soares G. Partial splenic embolization in the treatment of patients with portal hypertension: a review of the English language literature. J Vasc Interv Radiol 2007; 18 (04) 463-481
• 32 Yoshida H, Mamada Y, Taniai N, Tajiri T. Partial splenic embolization. Hepatol Res 2008; 38 (03) 225-233
• 33 Becker CD, Rösler H, Biasiutti FD, Baer HU. Congestive hypersplenism: treatment by means of radioembolization of the spleen with Y-90. Radiology 1995; 195 (01) 183-186
• 34 Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR. Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. JAMA 1993; 270 (15) 1826-1831
• 35 Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet 2011; 378 (9785): 86-97
• 36 Olthof DC, Lammers AJ, van Leeuwen EM, Hoekstra JB, ten Berge IJ, Goslings JC. Antibody response to a T-cell-independent antigen is preserved after splenic artery embolization for trauma. Clin Vaccine Immunol 2014; 21 (11) 1500-1504
• 37 Spigos DG, Jonasson O, Mozes M, Capek V. Partial splenic embolization in the treatment of hypersplenism. AJR Am J Roentgenol 1979; 132 (05) 777-782
• 38 Kandarpa K, Machan L, Durham JD. Handbook of Interventional Radiologic Procedures. 5th ed. Philadelphia, PA: Wolters Kluwer; 2016
• 39 Wojcicki M, Pakosz-Golanowska M, Lubikowski J, Post M, Jarosz K, Milkiewicz P. Direct pressure measurement in the hepatic artery during liver transplantation: can it prevent the “steal” syndrome?. Clin Transplant 2012; 26 (02) 223-228
• 40 Jung DH, Park CS, Ha TY. , et al. Placement of an aortohepatic conduit as an alternative to standard arterial anastomosis in liver transplantation. Ann Transplant 2018; 23: 61-65
• 41 Song JY, Shi BY, Zhu ZD. , et al. New strategies for prevention and treatment of splenic artery steal syndrome after liver transplantation. World J Gastroenterol 2014; 20 (41) 15367-15373