Safety and efficacy of splenic artery embolization for the treatment of gastric variceal bleeding secondary to left-sided portal hypertension

Background: Left-sided portal hypertension (LPH) is an uncommon clinical condition resulting from splenic vein stenosis/occlusion, which may cause bleeding from gastric varices. This study reviewed the long-term safety and efficacy of splenic artery embolization for the treatment of gastric varix bleeding secondary to splenic vein thrombosis.Methods: From April 2008 to March 2020, all consecutive patients diagnosed with LPH-associated variceal bleeding who had undergone percutane-ous splenic artery embolization were reviewed retrospectively. Patients' demographics, etiology of splenic vein thrombosis, embolization level and techniques, adverse events after embolization, and rebleeding rate were reviewed.Results: Twenty-two patients received splenic artery embolization for bleeding gastric varices in the setting of LPH. Three patients who underwent subsequent splenectomy were excluded. Median age was 44.5 years (range: 27-83 years) and 13 were male. Etiologies of splenic vein thrombosis were pancreatitis (n = 9), chronic liver disease (n = 6), and hematologic abnormalities (n = 4). Technical success was achieved in all 19 patients. Em-bolization level and material were as follows: proximal splenic artery coil embolization (n = 9), partial splenic parenchymal embolization with coils or particles (n = 7), and total parenchymal embolization with particles (n = 3). Procedure-related adverse events developed in 2 patients (one pleural effusion and one ileus with leukocytosis). During the median follow-up of 55 months (range, 7-165 months), two rebleeding events occurred 29 and 111 months after initial embolization, and both were successfully treated with repeat splenic artery embolization (n = 1) and transhepatic variceal embolization (n = 1).Conclusion: Splenic artery embolization for variceal bleeding secondary to LPH is safe and feasible. A total of 10.5% patients had delayed rebleeding more than 2 years after the index procedure, and both were successfully managed by repeat splenic artery embolization or transhepatic variceal em-bolization.Copyright (c) 2023, Society of Gastrointestinal Intervention.