Partial splenic embolization [PSE] in Egyptian patients with thalassemia major

ABSTRACT

The work is a trial to assess the value of partial splenic embolization as a new method of radiological interventional procedures that may be an alternative to surgical splenectomy in thalassemia major, the commonest hemolytic anemia in Egypt. In this work, PSE was done in six patients with thalassemia major including one case of sickle beta thalassemia. They included 4 males and 2 females with ages ranging from 3 to 12 years. Embolization was done using Gelfoam in five cases and an autologous blood clot in one case by superselective catheterization of the splenic artery. The extent of embolization was from 70% to 80% in five cases and 35% in one case. Follow up was done for periods up to 22 months by clinical and laboratory evaluation, ultrasound isotopic scanning and CT. PSE was successfully done in five of them with different responses. Three cases showed dramatic improvement with marked reduction of blood transfusion rate, decrease in the splenic size and improvement of the growth rate of the patient. One case had subintimal injection of contrast in the splenic artery which resulted in thrombosis of the splenic artery and extensive infarction of the spleen that gave good results in the follow up period. One case was complicated by a refluxing embolus resulting in small perforation in the lesser curvature of the stomach that necessitated laparotomy and splenectomy. In one case, the extent of embolization was not sufficient to give good results: