E4831. Splenic Artery Embolization for Management of Portal Hypertension: A Systematic Review and Metanalysis
  1. Sara Hassanzadeh; Isfahan University of Medical Sciences; Tehran University of Medical Sciences
  2. Hamed Ghorani; Shahid Beheshti Medical-University of Medical Sciences; Tehran University of Medical Sciences
  3. Ashley Bancroft; Baylor College of Medicine
  4. Amir Azimi; Iran University of Medical Sciences
  5. Mahsa Heidari-Foroozan; Shahid Beheshti Medical-University of Medical Sciences
  6. Shadi Nouri; Arak University of Medical Sciences
  7. Mohammad Ghasemi Rad; Baylor College of Medicine
The purpose of this systematic review and meta-analysis is to evaluate the role of splenic artery embolization (SAE) in managing portal hypertension caused by diverse etiologies. Our study focuses on the efficacy of SAE in improving clinical symptoms and laboratory markers in patients with portal hypertension and examines possible complications associated with this procedure. Technical aspects and procedural details of SAE, such as using types of embolic agents, proximal versus distal embolization, the percentage of splenic infarction achieved after the procedure, and antibiotics use in conjunction with the procedure will also be examined.

Materials and Methods:
A comprehensive search was conducted in electronic databases, including PubMed, Web of Science, Embase, and Scopus, to identify studies on the effectiveness of SAE in patients with portal hypertension. Original research articles reporting clinical outcomes were included, while case reports and literature reviews were excluded. Data extraction involved study characteristics, clinical and laboratory findings before and after the procedure, technical aspects of the procedure, such as the type and size of embolic material used, antibiotic use during the procedure, percentage of splenic infarction, and postprocedure complications ranging from mild to severe. Heterogeneity among studies was evaluated using the I2 statistic. When applicable, a meta-analysis was performed to synthesize the results and provide a comprehensive overview of the role of SAE in treating portal hypertension.

Improvement in hematologic parameters, such as platelet and white blood cell counts, were observed in most studies following SAE for portal hypertension. However, there was significant heterogeneity among the studies regarding the SAE protocols used, including the type of embolic material and its size, the use of antibiotics during the procedure, the percentage of splenic infarction, and the reported complications. The most common complications reported were fever and pain, while more severe complications such as pleural effusion, splenic vein thrombosis, and recurrent gastrointestinal bleeding were observed in some cases.

Our findings indicate that SAE is a feasible and effective method in managing portal hypertension with various underlying conditions. Despite the potential complications, the advantages of SAE, such as its minimally invasive nature and ability to maintain partial spleen function, render it a viable treatment option.