P225 Partial splenic artery embolisation for portal hypertension – a single centre experience

Introduction Variceal Haemorrhage (VH) which is refractory to medical and endoscopic secondary prophylaxis can be a challenge. When TIPS is not possible, as is sometimes the case in the setting of mesenteric venous thrombosis, partial splenic artery embolization (SAE) has been demonstrated as an effective rescue therapy. However, serious complications have been reported in up to one third of patients. Methods A radiology database search revealed 143 splenic embolisation procedures performed between September 2008 and December 2019. Following exclusion for splenic haemorrhage in trauma or splenic artery aneurysms in patients with pancreatitis, 8 patients received partial splenic artery embolisation for portal hypertension related indications Results 8 patients received partial SAE (targeting 50% of splenic volume) to treat complications of portal hypertension between November 2015 and September 2019. The median age was 46, aetiology of portal hypertension was, extrahepatic portal venous thrombosis (n=5), PSC (n=1), PBC (n=1) and obliterative portal venopathy (n=1). 2 patients previously had liver transplants. The indications for embolisation were splenomegaly associated abdominal pain (n=1), ascites (n=1) and recurrent VH (n=6). One patient had ascites (grade 3) pre-procedure. Post-embolisation median platelet and total white cell counts increased from 67 to 105 × 10^9/L and 2.1 to 4.7 × 10^9/L respectively and median bilirubin reduced from 26 umol/L to 16 umol/L. After the procedure 0/6 patients embolised for VH had a recurrence. 7 out of 8 patients developed post-embolisation syndrome and 2 patients developed pleural effusions which did not require drainage. 1 patient had a puncture site haematoma treated conservatively. The patient embolised for ascites developed SBP and decompensated further, requiring transplantation 23 days after embolisation. 2 of 8 patients died following embolisation, one after 5 months from liver abscesses in a failing graft and the other 15 months later from an unrelated cause. Conclusions In selected cases partial splenic embolisation can ameliorate portal hypertension (as evidenced by increasing white cell and platelet counts) and prevent recurrent VH. The majority of patients will develop post-embolisation syndrome and serious complications occurred in 3 of 8 patients. Further investigation into splenic embolisation as a treatment for portal hypertension in selected patients may be beneficial.