Abstract
Changes in portal hemodynamics after partial splenic embolization (PSE) was evaluated in patients with hypersplenism associated with portal hypertension. Thirty patients who underwent PSE were included. Volume of splenic infarction was calculated by summing width of infarcted area of the spleen in each plane of CT obtained after PSE, and the patients were divided into 2 groups with high infarction volume and low infarction volume. Portal and splenic venous blood flow were measured with pulsed Doppler ultrasonography. Esophagogastric varices were observed before and after PSE. Wedged hepatic venous pressure gradient was significantly decreased just after PSE. In patients with high pressure gradient before PSE and low infarction volume, however, the pressure gradient elevated again in 15 min. Although portal blood flow did not show significant change in both groups 1 year after PSE, splenic venous blood flow decreased significantly in the high infarction volume group. Esophageal varix was improved in 2 patients with infarction volume amounting to 79% and 70%. These results suggest that 1) Portal pressure decreases just after PSE, but in cases with severe portal hypertension and low infarction volume, compensatory mechanism works immediately after the procedure and elevates the pressure again, 2) Sufficient splenic infarction causes persistent decrease in splenic venous blood flow, and in some cases, causes decreased portal venous pressure and regresses esophageal varix.
