Short-term hemodynamic effects of splenic blood flow modulation after partial splenic artery embolization for secondary prevention of esophageal variceal bleeding

Abstract

Partial splenic artery embolization (PSE) is used in the management of portal hypertension to reduce splenic inflow. However, its hemodynamic impact in the secondary prophylaxis of esophageal variceal bleeding requires additional investigation.

Objective –  to assess changes in splenic hemodynamics after PSE for secondary prevention of variceal bleeding.

Materials and methods. The study included 90 patients (mean age 49.5 years) with a history of variceal bleeding and splenomegaly (mean volume 781.6 cm³). Splenic hemodynamics were evaluated using Doppler ultrasound at baseline and 1 month after PSE. Splenic volume and complications were monitored for up to 12 months.

Results. One month after PSE, splenic artery diameter decreased from 5.77±1.20 to 4.72±1.14 mm (p<0.001). Peak systolic velocity declined (152.92±50.35 to 89.77±34.28 cm/s, p<0.001), and end-diastolic velocity decreased (56.76±21.93 to 38.18±15.59 cm/s, p<0.001). Both resistance (0.63±0.08 to 0.58±0.13, p<0.05) and pulsatility indices (1.07±0.24 to 0.95±0.27, p<0.01) reduced significantly. Splenic volume initially increased to 831.7 cm³ due to edema but significantly decreased to 504.2±209.8 cm³ by month 6 (p<0.001), with this reduction sustained through month 12. Post-embolization syndrome was managed conservatively in 99% of cases; one instance of splenic abscess occurred. Conversely, the sclerotherapy comparison group showed increased splenic volume.

Conclusions. PSE induces significant short-term attenuation of splenic arterial inflow and venous outflow, followed by a substantial reduction in splenic volume. It is an effective adjunct for secondary prophylaxis with a predictable safety profile. Future comparative studies using unified hemodynamic protocols are required.