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Clinical benefits of partial splenic embolization for cancer patients.

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November 2024

Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.

Partial splenic embolization (PSE) has developed as an alternative to surgical splenectomy, mainly to improve hypersplenism and esophagogastric varices in cirrhotic patients. We proposed the novel concept that splenic infarction volume, rather than the splenic infarction ratio, is essential for patients receiving PSE. A splenic infarction volume between 388 and 540 mL is suitable for a sufficient increase in platelet count and less severe PSE-related complications.

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A 51-year-old man, with a history of cirrhotic portal hypertension and recurrent transjugular intrahepatic portosystemic shunt (TIPS) stenoses, presented with an acute gastro-esophageal variceal hemorrhage in the setting of an acute and massive thrombotic TIPS shunt occlusion. The clinical presentation was complicated by patient's severe, chronic thrombocytopenia which had precluded empiric anticoagulation previously for recurrent TIPS dysfunction. Following endoscopic treatment of the variceal bleeding, the CAT 12 Indigo aspiration system (Penumbra) was used to remove a large burden of thrombus from the TIPS, allowing successful re-stenting and restoration of blood flow through the TIPS.

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