Clinical effect of modified splenic artery embolization in treatment of hypersplenism and splenic artery steal syndrome due to liver cirrhosis

Objective To investigate the clinical effect of modified splenic artery embolization of the splenic artery and branch arteries in the treatment of splenic artery steal syndrome (SASS) and hypersplenism due to liver cirrhosis, since in patients with liver cirrhosis complicated by hypersplenism, the enlarged splenic artery competitively“steals”the blood flow in the celiac trunk and causes hypoperfusion in the hepatic artery (i.e., SASS due to liver cirrhosis) .Methods A total of 220 cirrhotic patients with hypersplenism and SASS who were hospitalized in General Hospital of the PLA Rocket Force and Chinese PLA General Hospital from January 2007 to December 2015 were enrolled and divided into medical treatment group with 120 patients (drugs combined with endoscopic intervention) , partial splenic embolization (PSE) with 40 patients (PSE combined with medical treatment) , and modified splenic artery embolization (MSAE) group with 60 patients (embolization of the splenic artery and branch arteries combined with medical treatment) .Related indices were analyzed and compared between the three groups.A one-way analysis of variance was used for comparison of continuous data between three groups, and the least significant difference t-test was used for further comparison between two groups;the chi-square test was used for comparison of categorical data between groups;the Kaplan-Meier survival analysis was used to calculate survival rates and gastrointestinal bleeding rate;the log-rank test was used to evaluate statistical difference.Results Within 5 years after surgery, the MSAE group had significantly higher platelet and leukocyte counts than the medical treatment group (P<0.05) .At 6 months after surgery, the MSAE group had a significantly lower Child-Pugh score than the medical treatment group (P<0.001) and the PSE group (P=0.014) ;at 1 year after surgery, the MSAE group still had a significantly lower Child-Pugh score than the medical treatment group (P=0.009) .At 6 months after surgery, the MSAE group had a significantly lower Model for End-Stage Liver Disease (MELD) score than the medical treatment group (P=0.004) and the PSE group (P=0.048) ;at 1 year after surgery, the MSAE group still had a significantly lower MELD score than the medical treatment group (P=0.012) .The MSAE group had significantly lower numbers of gastrointestinal bleeding/rebleeding events and endoscopic therapies than the PSE group (χ2=9.41, P=0.009) and the medical treatment group (χ2=10.91, P=0.004) ;at 5 years after surgery, the MSAE group still had a significantly lower incidence rate of gastrointestinal bleeding/rebleeding than the medical treatment group (χ2=14.70, P=0.002) .The MSAE group had certain improvements in the degree and duration of postoperative complications (pyrexia and abdominal pain) and had a lower incidence rate of serious complications (splenic abscess) , as compared with the other two groups.The median survival time was 45 (8-91) months in the MSAE group, 41 (6-86) months in the PSE group, and 34.5 (7-84) months in the medical treatment group.During the 5-year follow-up, 7 patients (11.7%) in the MSAE group, 40 (30%) in the medical treatment group, and 7 (17.5%) in the PSE group died.The MSAE group had a significantly higher cumulative survival rate than the medical treatment group (χ2=9.733, P=0.001) .Conclusion Modified splenic artery embolization of the splenic artery and branch arteries has good safety and can effectively correct hypersplenism and SASS due to liver cirrhosis, improve liver function, and reduce the risk of gastrointestinal bleeding.Therefore, it deserves further investigation.