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
