Underutilized Splenic Artery Embolization for Non-Traumatic Indications – Techniques, Outcomes, and Clinical Insights

• Highlight the growing use of splenic artery embolization (SAE) for non-traumatic splenic conditions with case examples.


• Explore proximal/partial embolization techniques and tailored embolic material selection.


• Discuss postprocedural care, including prophylactic vaccination guidelines and complication management strategies. 

SAE is a versatile and effective tool frequently employed by interventional radiologists, yet there remains a gap in its broader non-traumatic applications. SAE effectively manage splenic steal syndrome, portal hypertension, coagulopathies, hypersplenism, and as preparation for splenectomy. 

 

Clinical Findings/Procedure Details:

SAE in the non-traumatic setting is summarized in Table 1, including the various physiologic mechanisms, indications and different techniques. 

Proximal SAE (pSAE) with coils or plugs mimics splenic artery ligation, preserving splenic volume and function while minimizing infarction risks {1}. Partial SAE (PSE) using particles or liquid embolics induces 30-40% controlled infarction {2}. A combined distal and proximal approach may also be used in certain cases.

Relative contraindications include hepatofugal flow (risk of portal/splenic vein thrombosis), severe coagulopathy, and decompensated liver failure. Prophylactic antibiotics are recommended. Vaccines may not be required {3}. Post-embolization syndrome is common, requiring attention to relevant signs and symptoms.

 

Conclusion and/or Teaching Points:

SAE offers broad non-traumatic application. Interventional radiologists need a thorough understanding of its indications, techniques, and potential complications, with careful attention to timing and patient-specific factors for optimal outcomes and safety.