Endovascular Reduction of Splenic Blood Flow in the Treatment of Patients with Liver Cirrhosis

Abstract

Purpose: Defining the effectiveness of the embolization of the splenic artery (ESA) in the treatment of patients with liver cirrhosis. Materials and Methods: We have analyzed the results of treatment 318 patients with cirrhosis who were hospitalized in the 2-clinic of the Tashkent Medical Academy in 2007-2014. Most of the patients (201) were males, mean age was 35.1±17.7 years. For the purpose of monitoring performed comprehensive study, including clinical, laboratory and special instrumental methods of research. To assess the severity of the Hepatic Failure (HF) used classification of Child-Turcotte-Pugh (CTP). Bleeding from the esophagus and stomach varices history was noted in 207 (65.1%) patients, in 151 (47.5%) of them had been made endoscopic ligation varices of esophagus and stomach and 56 (17,6%) patients was successfully performed percutaneous transhepatic embolization coronary vein and short gastric vein using the technique described by Lunderquist et al. Pronounced hemodynamic disorder on the background of anemia accompanied by deteriorated metabolic and functional status of the liver and other organs. Therefore, 32.0% detected HF class-A by CTP, at 45.6% - Class-B and 22.4% -Class C. The indications for ESA are splenomegaly with hypersplenism, and without it, varices of esophagus and stomach, high portal pressure (PP). Contraindications were severe general condition of the patient, the high activity of cirrhotic process, which was estimated at the level of bilirubin and ALT, AST. Results: The effectiveness of endovascular interventions we evaluated on the following criteria: changes in general clinical and biochemical parameters of blood, portal blood flow dynamics and the state of varices of esophagus and stomach, the incidence of bleeding, the overall mortality rate and life expectancy. Laboratory analysis was carried out after stabilization of the patients in terms from 1 to 3 months, revealed an increase in cellular composition and the level of hemoglobin. The number of leukocytes increased to 6.8±0.24×109/L, platelet – to176.3±15.8×109/L,34 the hemoglobin level was 94.7±12.4 g/l. The increase in arterial blood supply of the liver caused by the redistribution of blood flow after ESA, accompanied by an improvement of the functional state of the liver, which evaluated by a number of clinical and laboratory parameters in 37 the at 1 month, 3 months, 6 months and 12 months. Results of the study of the portal system show that in the period of 3 months after the ESA with a decrease of PP428,7±10,2 to 342,3±12,6 mm of water. Conclusion: Splenic artery embolization after endoscopic band ligation varices of esophagus and stomach or transhepatic embolization coronary vein and short gastric vein reduces the risk of rebleeding and maybe use as method for improve liver function and decrease of portal hypertension.