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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2023; 07(01): 008-014
DOI: 10.1055/s-0042-1743499
Original Article

Closure of Transsplenic Access Tracts Using Tract Embolics: Success, Clinical Outcomes, and Complications in a Tertiary Center

David Rigual 
2   Division of Vascular and Interventional Radiology, UCLA, Ronald Reagan Medical Center, Los Angeles, California, United States
,
Isaac Chen 
1   California Northstate University College of Medicine, Elk Grove, California, United States
,
Dustin L. Roberts 
2   Division of Vascular and Interventional Radiology, UCLA, Ronald Reagan Medical Center, Los Angeles, California, United States
,
James Sayre
2   Division of Vascular and Interventional Radiology, UCLA, Ronald Reagan Medical Center, Los Angeles, California, United States
,
Ravi Srinivasa
2   Division of Vascular and Interventional Radiology, UCLA, Ronald Reagan Medical Center, Los Angeles, California, United States
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Abstract

Purpose The aim of the study was to evaluate the safety and effectiveness of transsplenic venous access closure.

Materials and Methods Twenty patients (mean age: 51.8 years; range: 28–72), underwent 21 transsplenic venous access procedures over 4 years in this retrospective study. Comorbidities, active hemorrhage, anticoagulation, coagulation parameters, platelets, indications for transsplenic access, needle gauge, sheath size, variceal embolization method, tract embolization method, bleeding complications, and transfusion requirements and additional procedures to manage bleeding complications were recorded.

Results Preprocedure comorbidities included portal hypertension (n = 18/20, 90%), portal vein thrombosis (n = 14/20, 70%), hemorrhage (n = 6/20, 30%), splenic vein thrombosis (n = 7/20, 35%), anticoagulation (n = 2/20, 10%), and sinistral portal hypertension (n = 2/20,10%). Mean baseline international normalized ratio was 1.3 (range: 1–1.9), platelets 122 (range: 18–492). Most common transsplenic access indications were gastric varices with nonpatent portosystemic shunt (n = 11/21, 52%) and portal vein targeting for transjugular intrahepatic portosystemic shunt (n = 8, 38%). Most common access sheath sizes were 4-French (n = 5, 24%) and 6-French (n = 6, 29%). Fifteen procedures (71%) involved variceal embolization. Transsplenic tracts were embolized with microfibrillar collagen alone (n = 7), coils and microfibrillar collagen (n = 8), or others (n = 6). Based on the Society of Interventional Radiology adverse event classification system, embolization complications included one major (splenic artery pseudoaneurysm and a splenic vein pseudoaneurysm) and three moderate (19%) adverse bleeding events, which required blood transfusion.

Conclusion Transsplenic venous access tract embolization is a safe and moderately effective method to achieve tract hemostasis, with an overall clinical failure rate of 20%.

Keywords

transsplenic access - microfibrillar collagen - hemostasis

Ethical approval

The article was exempted from an ethical committee approval.




Publication History

Article published online:
08 March 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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