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Monday, June 8, 2015

Proximal splenic artery embolization appears to be a safe alternative to distal splenic embolization in the setting of chemotherapy induced thrombocytopenia

Chemotherapy induced thrombocytopenia results in suboptimal cancer treatment due to interruption of chemotherapy and reduced dosing, as well as complications secondary to bleeding and transfusion. Distal splenic artery embolization is an alternative to medical therapy for CIT; however, there is a high rate of post-embolization syndrome associated with the procedure. In this retrospective study, 13 patients underwent proximal splenic artery embolization for CIT. Embolization of the splenic artery was performed distal to the origin of the dorsal pancreatic and pancreatica manga arteries with platinum coils oversized by 2-3 mm. The mean post procedure peak platelet count was 209x109 /L, increased from an average of 45x109 /L (p<0.01.) All patients were deemed eligible to resume chemotherapy by their oncologists. The splenic infarction rate at follow up was 29.5%. One patient developed symptoms consistent with post-embolization syndrome, and was treated with tramadol and Medrol dose pack. As an alternative to distal splenic embolization, the authors show that PSAE is safe, and allowed the patients studied to resume chemotherapy on average by 22 days post-procedure. Additionally, the splenic infarction rate appears lower than has been reported for DSE, resulting in a lower rate of post-embolization syndrome.

Comment:
Within the limitations of a small sample size, the current study demonstrates that PSAE is a safe alternative to DSE. The mean platelet count increased significantly after treatment, and all of the patients were deemed eligible to resume chemotherapy by their treating oncologists. Further investigation is warranted to compare PSAE and DSE in terms of efficacy and complication rate.


Click here to see the full abstract


Images from a 69-year-old man with a history of cholangiocarcinoma who developed CIT while he was being treated with gemcitabine and cisplatin. The platelet count decreased to 32 109/L; chemotherapy was discontinued and the patient was referred for PSAE. Pre-PSAE MR imaging (a) and splenic artery angiography (b) show an enlarged spleen consistent with hypersplenism. (c) DSA demonstrates coil embolization of the main splenic artery. (d) MR imaging at 1-year follow-up shows significant reduction in size of the spleen and a large area of infarct replacing approximately 50% of splenic parenchyma.


Citation: Bhatia, S. S. et al. Proximal Splenic Artery Embolization in Chemotherapy-Induced Thrombocytopenia: A Retrospective Analysis of 13 Patients. Journal of Vascular and Interventional Radiology (2015). doi:10.1016/j.jvir.2015.04.003


Post author: Timothy Huber MD, VIR Pathway Resident, University of Virginia


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