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Wu T, Sun R, Huang Y, Wang Z, He J, Shen S, Yin X, Zhu Z, Yang W, Zhao Z. Partial splenic embolization of patients with hypersplenism by transradial or transfemoral approach: a prospective randomized controlled trial. Acta Radiol 2016; 57:1201-4. [PMID: 26671306 DOI: 10.1177/0284185115622076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 11/13/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Partial splenic artery embolization (PSE) is an effective treatment modality for patients with hypersplenism. It is less invasive and has a quicker recovery compared with surgical procedures. PSE is usually performed using a femoral artery approach that requires bedrest for a few hours, which is rarely the case for transradial PSE. PURPOSE To compare the transradial and transfemoral approaches for embolization of spleen in patients with hypersplenism. MATERIAL AND METHODS In all, 84 patients with hypersplenism who required PSE were recruited. They were randomly divided into two groups on the basis of the procedure followed: the transradial approach (R-PSE, n = 39) or transfemoral approach (F-PSE, n = 45). Technical success, puncture rate, total procedure time, X-ray exposure time, length of stay in hospital (LOS), and complications of the two groups were recorded. RESULTS The procedure time, X-ray exposure time, and LOS were found to be lower in the R-PSE group than in the F-PSE. However, this difference was not statistically significant. CONCLUSION The transradial artery approach for PSE in patients with hypersplenism is feasible with no major complications as compared to the femoral approach.
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Affiliation(s)
- Tao Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Ruimin Sun
- Department of Operation Room, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Yinuo Huang
- Department of Gastroenterology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Zhixue Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Jue He
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Songhe Shen
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Xiaoxiang Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Zhixiang Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Wenyi Yang
- Department of Gastroenterology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Zhijun Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
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Zhu J, Chen X, Hu X, Zhu H, He C. A Comparative Study of Surgical Splenectomy, Partial Splenic Embolization, and High-Intensity Focused Ultrasound for Hypersplenism. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:467-474. [PMID: 26839374 DOI: 10.7863/ultra.15.03050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This study compared splenectomy, partial splenic embolization, and high-intensity focused ultrasound (HIFU) therapy, which represent the traditional, mature, and newest methods for improving thrombocytopenia in hypersplenism, respectively. METHODS A total of 69 patients with hypersplenism were treated with surgical splenectomy (n = 31), HIFU (n = 26), or partial splenic embolization (n = 12). They were followed closely for at least 6 months, and the effectiveness of the treatments was compared. RESULTS Among the 3 groups, splenectomy was the most effective treatment for increasing peripheral blood cells. Embolization reduced the operating time and hospital stay, but HIFU was relatively safer and less invasive than the other treatments. CONCLUSIONS High-intensity focused ultrasound has wide clinical indications for hypersplenism and may be safer than other treatment methods. Therefore, it is a good alternative procedure for patients with a high surgical risk.
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Affiliation(s)
- Jing Zhu
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.)
| | - Xijun Chen
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.)
| | - Xiaotong Hu
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.)
| | - Hui Zhu
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.)
| | - Chao He
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University and Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (J.Z., X.C., X.H., C.H.); Clinical Center for Tumor Therapy, Second Clinical College and Affiliated Hospital, Chongqing Medical University, Chongqing, China (H.Z.); and Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China (C.H.).
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Microwave Ablation for the Treatment of Hypersplenism: Short Waves, Low Cost, Big Results. Dig Dis Sci 2016; 61:6-7. [PMID: 26541991 DOI: 10.1007/s10620-015-3928-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Martins GLP, Bernardes JPG, Rovella MS, Andrade RG, Viana PCC, Herman P, Cerri GG, Menezes MR. Radiofrequency ablation for treatment of hypersplenism: A feasible therapeutic option. World J Gastroenterol 2015; 21:6391-6397. [PMID: 26034376 PMCID: PMC4445118 DOI: 10.3748/wjg.v21.i20.6391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/06/2014] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient’s underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation (RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.
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Gao F, Gu YK, Shen JX, Li CL, Jiang XY, Huang JH. Experimental study of destruction to porcine spleen in vivo by microwave ablation. World J Gastroenterol 2011; 17:5014-20. [PMID: 22174552 PMCID: PMC3236583 DOI: 10.3748/wjg.v17.i45.5014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 05/06/2011] [Accepted: 05/13/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To discuss the safety, feasibility and regularity of destruction to porcine spleen in vivo with congestion and tumescence by microwave ablation (MWA).
METHODS: Ligation of the splenic vein was used to induce congestion and tumescence in vivo in five porcine spleens, and microwave ablation was performed 2-4 h later. A total of 56 ablation points were ablated and the ablation powers were 30-100 W. The ablation time (1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 min) was performed at a power of 60 W. After ablation, the ablation size was measured in pigs A, C, D and E and spleen resection. In pig B, the ablation size was measured and 2 ablation points were sent for pathology analysis and all tissues were sutured following ablation. Pig B was killed 1 wk later and the ablation points were sent for pathology analysis. Bleeding, tissue carbonization surrounding electrodes, and pathological changes were observed, and the effect on destruction volume relative to different ablation powers, times and positions was analyzed.
RESULTS: The incidence of bleeding (only small am-ounts, < 20 mL) in the course of ablation was 5.4% (3/56) and was attributed to tissue carbonization surrounding electrodes, which also exhibited an incidence of 5.4% (3/56). The destruction volume was influenced by different ablation powers, times and points. It showed that the ablation lesion size increased with increased ablation time, from 1 to 10 min, when the ablation power was 60 W. Also, the ablation lesion size increased with the increase of ablation power, ranging from 30 to 100 W when the ablation time was set to 3 min. A direct correlation was seen between the destruction volume and ablation time by the power of 60 W (r = 0.97542, P < 0.0001, and also between the destruction volume and ablation powers at an ablation time of 3 min (r = 0.98258, P < 0.0001). The destruction volume of zone II (the extra-2/3 part of the spleen, relative to the first or second class vascular branches), which was near the hilum of the spleen, was noteably larger than the destruction volume of zoneI(the intra-1/3 part of the spleen) which was distal from the hilum of the spleen (P = 0.0015). Pathological changes of ablation occurring immediately and 1 wk after MWA showed large areas of coagulation. Immediately following ablation, intact spleen tissues were observed in the areas of coagulation necrosis, mainly around arterioles, and there were no obvious signs of hydropsia and inflammation, while 1 wk following the ablation, the coagulation necrosis was well distributed and complete, as many nuclear fragmentations were detected, and there were obvious signs of hydropsia and inflammation.
CONCLUSION: In vivo treatment of congestion and tumescence in the spleen using microwave ablation of water-cooled antenna is a safe and feasible method that is minimally invasive.
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Microwave ablation in the spleen for treatment of secondary hypersplenism: a preliminary study. AJR Am J Roentgenol 2011; 196:692-6. [PMID: 21343515 DOI: 10.2214/ajr.10.4193] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the feasibility, safety, and efficacy of microwave (MW) ablation for the treatment of hypersplenism, via a laparoscopic or percutaneous approach, and its effect on liver function in patients with liver cirrhosis. SUBJECTS AND METHODS Twenty patients (17 men and three women; mean age, 51.7 ± 11.4 years; age range, 31-68 years) with secondary hypersplenism resulting from liver cirrhosis were treated with MW ablation of splenic parenchyma (13 laparoscopically and seven percutaneously with ultrasound guidance). Splenic volume and ablated volume were calculated according to contrast-enhanced CT scan. Routine blood counts (platelet, leukocyte, and erythrocyte counts) and liver function test results were examined before and after MW ablation. RESULTS The mean follow-up period was 26.4 ± 11.4 months (range, 6-48 months). After MW ablation, the ablation ratio ranged from 16% to 58% (mean, 30.9% ± 13%). All patients showed an increase in platelet count and leukocyte count after MW ablation, and patients with an ablation ratio greater than 40% showed more sustainable increase of platelet count in the follow-up period. Serum total protein levels significantly increased (p < 0.05). No severe complications occurred. CONCLUSION MW ablation is a safe and effective technique for the management of hypersplenism in patients with liver cirrhosis. Ablating more than 40% of the splenic parenchyma may yield better long-term results.
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915MHz microwave ablation with high output power in in vivo porcine spleens. Eur J Radiol 2009; 75:87-90. [PMID: 19349134 DOI: 10.1016/j.ejrad.2009.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/18/2009] [Accepted: 03/06/2009] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of 915 MHz microwave (MW) ablation with high output power in in vivo porcine spleens. MATERIALS AND METHODS MW ablations were performed in 9 porcine spleens with an internally cooled 915 MHz antenna. Thermocouples were placed at 5, 10, 15, 20 mm away from the antenna to measure temperatures in real-time during MW emission. The energy was applied for 10 min at high output power of 60 W, 70 W or 80 W. Gross specimens were sectioned and measured to determine ablation size. Representative areas were examined by light microscopy and electron microscopy. Coagulation sizes and temperatures were compared among the three power groups. RESULTS Hematoxylin-eosin staining showed irreversible necrosis in the splenic coagulation area after MW ablation. As the power was increased, long-axis diameter enlarged significantly (p<.05). Short-axis diameter also tended to increase, but there were no statistical difference (p>.05). The coagulation size of long-axis and short-axis diameter with 80 W in vivo spleen ablation was 6.43+/-0.52 and 4.95+/-0.30 cm, respectively. With the increase of output power, maximum temperatures at 5, 10, 15, 20 mm from the antenna were increased accordingly (p<.05). The maximum temperature with 80 W at 5 and 20 mm from the antenna reached 146.17+/-6.65 and 72.38+/-4.23 degrees C respectively. CONCLUSION With internally cooled antenna and high output power, 915 MHz MW ablation in the spleen could produce irreversible tissue necrosis of clinical significance. MW ablation may be used as a promising minimally invasive method for the treatment of splenic diseases.
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Garibaldi B, King KE, Jaffe JM, Moliterno AR. Hypersplenism induced by splenic vein ligation. Am J Hematol 2008; 83:242-4. [PMID: 17874452 DOI: 10.1002/ajh.21069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Warm autoimmune hemolytic anemia (AIHA) is a rare clinical entity. It is usually caused by an IgG autoantibody directed against the red blood cell membrane that causes extravascular hemolysis predominantly in the spleen. As a result, disease states or procedures that result in hypersplenism would be expected to increase red cell destruction in patients with an underlying warm AIHA. We present the case of a patient with a previously undiagnosed warm AIHA, who developed worsening hemolysis after undergoing splenic vein ligation during a pancreaticoduodenectomy to remove a neuroendocrine tumor.
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Affiliation(s)
- Brian Garibaldi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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