Splenic Artery Syndrome After Orthotopic Liver Transplantation: Treatment With the Amplatzer Vascular Plug

• Published in: Cardiovascular and interventional radiology 2011-12, Vol.34 (6), p.1208-1213
• Main Authors: Maurer, M. H., Mogl, M. T., Podrabsky, P., Denecke, T., Grieser, C., Fröling, V., Scheurig-Münkler, C., Guckelberger, O., Kroencke, T. J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; AMINOTRANSFERASES; Angiography; ANIMALS; ARTERIES; ASCITES; AZOLES; BILIRUBIN; BLOOD VESSELS; BODY; CARBOXYLIC ACIDS; Cardiology; CARDIOVASCULAR SYSTEM; Clinical Investigation; Contrast Media; DIGESTIVE SYSTEM; Embolization, Therapeutic - instrumentation; ENZYMES; Female; FEMALES; GLANDS; HETEROCYCLIC ACIDS; HETEROCYCLIC COMPOUNDS; Humans; Imaging; LIVER; Liver Function Tests; Liver Transplantation; Male; MALES; MAMMALS; MAN; MATERIALS; MEDICINE; Medicine & Public Health; MEN; Middle Aged; NITROGEN TRANSFERASES; Nuclear Medicine; ORGANIC ACIDS; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANS; PATHOLOGICAL CHANGES; PATIENTS; PIGMENTS; Postoperative Complications - diagnostic imaging; Postoperative Complications - therapy; PRIMATES; PROTEINS; PYRROLES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; SAFETY; Septal Occluder Device; Splenic Artery; Splenic Diseases - diagnostic imaging; Splenic Diseases - therapy; SYMPTOMS; Syndrome; THERAPY; Tomography, X-Ray Computed; TRANSFERASES; Treatment Outcome; Ultrasound; VERTEBRATES; WOMEN
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-010-0083-9

Purpose To evaluate the safety and efficacy of the Amplatzer vascular plug (AVP) for embolization of the splenic artery in patients with hepatic hypoperfusion after orthotopic liver transplantation (OLT). Materials and Methods Thirteen patients (9 men and 4 women) with a mean age of 56 years (range 22–70) who developed splenic artery syndrome after OLT with decreased liver perfusion and clinically relevant impairment of liver function (increased transaminase or serum bilirubin levels, thrombocytopenia, and/or therapy-refractory ascites) were treated by embolization of the proximal third of the splenic artery using the AVP. The plugs ranged in diameter from 6 to 16 mm, and they were introduced through femoral ( n  = 9), axillary ( n  = 3), or brachial ( n  = 1) access using a 5F or 8F guiding catheter. Results The plugs were successfully placed, and complete occlusion of the splenic artery was achieved in all patients. Placement of two plugs was necessary for complete occlusion in 3 of the 13 patients. Occlusion took on average 10 min (range 4–35). There was no nontarget embolization or plug migration into more distal segments of the splenic artery. All patients showed improved arterial perfusion, including the liver periphery, on postinterventional angiogram. After embolization, liver function parameters (transaminase and bilirubin levels) improved with normalization of concomitant thrombocytopenia and a decrease in ascites volume. Conclusion Our initial experience in a small patient population with SAS suggests that the AVP enables precise embolization of the proximal splenic artery, thus providing safe and effective treatment for poor liver perfusion after OLT due to SAS.