Single-Institution Experience with Partial Splenic Embolization in Oncological Patients

Tuesday, April 1, 2025

4:12 PM – 4:21 PM CT

Location: Music City Center, 201 AB

Presenting Author(s)

Premsai Charan Kumar, MD

PGY-2 , Interventional Radiology Resident
USF Morsani College of Medicine, United States

Author/Co-author(s)

MB

Mahi Basra, BS

Medical Student
Nova Southeastern University, United States
JH

Jonathan Henning, BS

Medical Student
University of South Florida Morsani College of Medicine, United States
JC

Junsung Choi, MD

SR MBR DIAGRADINT
H. Lee Moffitt Cancer Center, United States
ES

Elias Salloum, MD

Assistant Member in the Department of Diagnostic Imaging and Interventional Radiology
Moffitt Cancer Center, United States
Bela Kis, MD, PhD, FSIR (he/him/his)

Chief of Interventional Radiology
Moffitt Cancer Center, United States

Purpose: To analyze the safety and efficacy of partial splenic bland embolization for oncological patients.

Materials and Methods: Medical records and imaging of 80 patients with various malignancies who underwent partial splenic bland embolization using 300-500 µm microspheres from November 2017 to July 2024 were retrospectively reviewed. There were 33 patients with underlying hematologic malignancies and 47 patients with non-hematologic malignancies. Splenic embolization was performed in 61 patients to improve platelet count and it was performed in 19 patients to reduce compressive symptoms from extreme splenomegaly. Pre- and post-embolization viable and infarcted splenic volumes were measured using 3D reconstruction software.

Results:

Splenic embolization was technically successful in 79/80 patients (98.75%). The baseline splenic volumes in the hematology group and non-hematology group were 2239.1±1634.8 and 902.6±432.5 mL, respectively. The post-embolization mean splenic infarct volumes were 1299.4±1140.9 and 467.2±279.8 mL, respectively, which were 58% and 51.8% of the baseline splenic volumes. 1 ml of the 300-500 µm embolization microspheres lead to 646.5±567.6 mL infarct volume in the hematology group and 295.7±177.1 ml in the non-hematology group. The baseline mean platelet count for the hematology group was 59.8±52.1. The mean post-embolization platelet count in the hematology group was 166.9±145.6 and 181±176.9 at 2 weeks and 3 months, respectively. The baseline mean platelet count for the non-hematology group was 74.1±21. The mean post-embolization platelet count in the non-hematology group was 175.6±82.4 and 145.5±54.2 at 2 weeks and 3 months, respectively.

Of the 79 successful procedures, 60 patient underwent celiac plexus neurolysis 24 hours post-splenic embolization. These patients reported 2-3 out of 10 pain during the first week after embolization, while patients without celiac block reported 7-10 pain. There were 4 major complications, including 2 splenic abscesses. 1 patient died within 6 hours of procedure, secondary to unknown causes.

Conclusion: Splenic embolization is a safe and effective treatment for oncological patients with thrombocytopenia and extreme splenomegaly. The same amount of embolization microspheres leads to significantly larger infarct volume in patients with hematological malignancies. Celiac plexus neurolysis is very effective in controlling post-embolization pain.