Home Procedures Partial Splenic Embolisation

Partial Splenic Embolisation

Partial splenic embolisation to treat hypersplenism and thrombocytopenia selectively reducing splenic size and improving blood counts while preserving splenic immune function. Performed by Dr. Gurucharan S Shetty at Sparsh Hospitals Bangalore.

Vascular Interventional Radiology

What is Partial Splenic Embolisation?

Partial Splenic Embolisation (PSE) is an interventional radiology procedure in which selected branches of the splenic artery are embolised deliberately infaracting 60–70% of the splenic parenchyma. This controlled reduction in splenic mass decreases the spleen's excessive destruction and sequestration of blood cells (hypersplenism), raising platelet counts, improving white cell counts, and reducing anaemia. Critically, PSE preserves 30–40% of functioning splenic tissue maintaining the spleen's essential immunological role against encapsulated organisms a major advantage over total splenectomy.

Who is This Procedure For?

Partial splenic embolisation is recommended for patients with symptomatic hypersplenism or massive splenomegaly when conservative management is inadequate. It is commonly indicated in thrombocytopenia due to portal hypertension, particularly in cirrhosis, where low platelet counts prevent necessary procedures such as liver biopsy, ablation, surgery, or the initiation of antiviral or chemotherapy treatments. It is also used in symptomatic hypersplenism with significant cytopenias, including low platelets, white blood cells, or haemoglobin, leading to clinical complications. Patients with massive splenomegaly causing early satiety, left-sided abdominal pain, and respiratory discomfort may benefit from this procedure. Additionally, it is considered in certain haematological conditions such as hereditary spherocytosis, thalassaemia, and immune thrombocytopenic purpura, especially when splenectomy carries a high risk. The procedure is also suitable for patients who are unfit for surgery due to coagulopathy, portal hypertension, or other comorbidities. Furthermore, partial splenic embolisation can be performed as a pre-procedure optimisation strategy to increase platelet counts before planned liver interventions, TIPSS, or surgery in cirrhotic patients.

How is Partial Splenic Embolisation Performed?

  • Pre-procedural Vaccination

    Patients receive pneumococcal, meningococcal, and Haemophilus influenzae type B vaccines at least 2 weeks before PSE to protect against post-embolisation infection risk.

  • Splenic Artery Catheterisation

    Under fluoroscopic guidance, a catheter is advanced from the femoral artery into the splenic artery. Angiography maps the splenic arterial anatomy.

  • Selective Distal Embolisation

    Microcatheter is advanced into distal splenic artery branches. PVA particles (300–500 microns) or microspheres are injected to selectively embolise 60–70% of the splenic parenchyma.

  • Targeted Parenchymal Preservation

    Embolisation is stopped when approximately 30–40% of splenic blood supply remains patent preserving immunological function.

  • Post-PSE Pain Management

    IV analgesia and antibiotics are administered for the expected post-embolisation syndrome. Blood counts are monitored daily. Platelet count typically begins rising within 5–10 days.

Benefits of This Procedure

Raises Platelet Count

Platelet counts typically double or normalise within 4–6 weeks enabling previously impossible procedures and therapies in thrombocytopenic patients.

Preserves Immunity

30–40% residual spleen maintains essential immune function against encapsulated organisms avoiding the life-threatening risk of post-splenectomy sepsis.

Avoids Splenectomy

PSE achieves similar haematological benefits to splenectomy without surgery particularly valuable in cirrhotic patients where surgical risk is very high.

Reduces Spleen Size

Significant reduction in spleen volume relieves bulk-related symptoms early satiety, left upper quadrant pain, and respiratory discomfort.

Frequently Asked Questions

Most patients experience a 2–4 fold increase in platelet count within 4–6 weeks. Patients with platelets of 30,000–50,000 commonly reach counts of 80,000–150,000 or higher sufficient for most procedures and therapies. The degree of improvement correlates with the extent of embolisation (targeting 60–70% of spleen volume) and the severity of underlying portal hypertension.
Post-embolisation syndrome after PSE is more pronounced than after liver embolisation because the spleen has fewer arterial collaterals and the infarction is more complete. Patients typically experience significant left-sided abdominal pain, fever (38–39°C), nausea, and fatigue for 5–10 days. This is managed with strong IV analgesics, anti-nausea medications, and antibiotics. Pain is expected and is managed proactively by Dr. Shetty's team.
Splenic abscess is the most serious complication of PSE, occurring in approximately 2–5% of cases. Risk is minimised by: limiting embolisation volume to 60–70% (not 100%), administering prophylactic IV antibiotics during and after the procedure, pre-procedure vaccination, and careful patient selection. Signs of abscess (persistent high fever, worsening pain, rising CRP after week 2) require CT imaging and may need percutaneous drainage.
Platelet count improvement is often durable many patients maintain adequate counts for 1–3 years. However, in portal hypertension patients, the spleen may regenerate over time as portal pressure drives ongoing splenomegaly, and counts may gradually fall again. Repeat PSE can be performed if needed. Regular blood count monitoring every 3–6 months is recommended.
Total splenectomy permanently eliminates hypersplenism but carries significant risks in cirrhotic patients surgical bleeding (coagulopathy, portal hypertension, varices), anaesthetic risk in liver failure, and lifelong susceptibility to overwhelming post-splenectomy sepsis from encapsulated organisms (pneumococcus, meningococcus, Haemophilus). PSE achieves similar haematological benefits with lower procedural risk and preserves immunological function, making it the preferred approach for most cirrhotic patients with symptomatic hypersplenism.
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Suffering from Low Platelet Count or Enlarged Spleen Due to Liver Disease?

Consult Dr. Gurucharan S Shetty at Sparsh Hospitals, Bengaluru for expert evaluation and minimally invasive management of hypersplenism and thrombocytopenia.

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