Splenic Artery Steal Syndrome in Patients with Liver Cirrhosis: A Retrospective Clinical Study

Overview

Journal Med Sci Monit

Specialties General Medicine
Pathology

Date 2023 Mar 7

PMID 36879520

Authors

Wei Mao

Xinhua Jiang

Sixuan Guo

Xuguang Hu

Yehong Yan

Affiliations

Soon will be listed here.

Abstract

BACKGROUND Splenic artery steal syndrome (SASS) can aggravate liver damage in patients with cirrhosis. This study explored whether SASS could be an effective therapeutic target for improving hepatic artery perfusion and liver function in patients with decompensated cirrhosis. MATERIAL AND METHODS Based on inclusion and exclusion criteria, 87 patients with hepatitis B cirrhosis and portal hypertension hypersplenism admitted to our General Surgery Department for splenectomy and pericardial devascularization surgery were selected. A total of 35 cases met the diagnostic criteria of SASS and were assigned to the SASS group; the remaining 52 cases were assigned to the control group. The indicators before, during, and after surgery were compared between the 2 groups. RESULTS There were no significant differences in preoperative and intraoperative indicators between SASS group and control group (P>0.05). The MELD score 7 days after surgery and the hepatic artery diameter and hepatic artery velocity 14 days after surgery in both groups were significantly better than before surgery. The MELD score 7 days after surgery in the SASS group was significantly better than that in the control group, and the hepatic artery diameter and hepatic artery velocity 14 days after surgery in the SASS group were significantly better than those in the control group (P<0.05). CONCLUSIONS Splenectomy and pericardial devascularization surgery was an effective treatment to redirect blood flow to the hepatic artery for cirrhotic patients diagnosed with SASS. The introduction of cirrhotic SASS into clinical practice may benefit more patients with cirrhotic portal hypertension and hypersplenism.

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References

Saad W . Nonocclusive hepatic artery hypoperfusion syndrome (splenic steal syndrome) in liver transplant recipients. Semin Intervent Radiol. 2013; 29(2):140-6. PMC: 3444879. DOI: 10.1055/s-0032-1312576. View

Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot J, Leandros E . Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2008; 22(4):821-48. DOI: 10.1007/s00464-007-9735-5. View

Langer R, Langer M, Scholz A, Felix R, Neuhaus P, Keck H . [The splenic steal syndrome and the gastroduodenal steal syndrome in patients before and after liver transplantation]. Aktuelle Radiol. 1992; 2(2):55-8. View

Kawanaka H, Akahoshi T, Kinjo N, Iguchi T, Ninomiya M, Yamashita Y . Effect of laparoscopic splenectomy on portal haemodynamics in patients with liver cirrhosis and portal hypertension. Br J Surg. 2014; 101(12):1585-93. DOI: 10.1002/bjs.9622. View

Indiran V, Vinod Singh N, Prasad T, Maduraimuthu P . Does coronal oblique length of spleen on CT reflect splenic index?. Abdom Radiol (NY). 2017; 42(5):1444-1448. DOI: 10.1007/s00261-017-1055-1. View

Quintini C, Hirose K, Hashimoto K, Diago T, Aucejo F, Eghtesad B . "Splenic artery steal syndrome" is a misnomer: the cause is portal hyperperfusion, not arterial siphon. Liver Transpl. 2008; 14(3):374-9. DOI: 10.1002/lt.21386. View

Linguraru M, Sandberg J, Jones E, Summers R . Assessing splenomegaly: automated volumetric analysis of the spleen. Acad Radiol. 2013; 20(6):675-84. PMC: 3945039. DOI: 10.1016/j.acra.2013.01.011. View

Ezzat W, Lautt W . Hepatic arterial pressure-flow autoregulation is adenosine mediated. Am J Physiol. 1987; 252(4 Pt 2):H836-45. DOI: 10.1152/ajpheart.1987.252.4.H836. View

Jakab F, Rath Z, Schmal F, Nagy P, FALLER J . The interaction between hepatic arterial and portal venous blood flows; simultaneous measurement by transit time ultrasonic volume flowmetry. Hepatogastroenterology. 1995; 42(1):18-21. View

10.

Lo C, Liu C, Fan S . Portal hyperperfusion injury as the cause of primary nonfunction in a small-for-size liver graft-successful treatment with splenic artery ligation. Liver Transpl. 2003; 9(6):626-8. DOI: 10.1053/jlts.2003.50081. View

11.

Dokmak S, Aussilhou B, Belghiti J . Liver transplantation and splenic artery steal syndrome: the diagnosis should be established preoperatively. Liver Transpl. 2013; 19(6):667-8. DOI: 10.1002/lt.23639. View

12.

Sevmis S, Boyvat F, Aytekin C, Gorur S, Karakayali H, Moray G . Arterial steal syndrome after orthotopic liver transplantation. Transplant Proc. 2006; 38(10):3651-5. DOI: 10.1016/j.transproceed.2006.10.145. View

13.

Manner M, Otto G, Senninger N, Kraus T, Goerich J, Herfarth C . Arterial steal: an unusual cause for hepatic hypoperfusion after liver transplantation. Transpl Int. 1991; 4(2):122-4. DOI: 10.1007/BF00336410. View

14.

Uflacker R, Selby J, Chavin K, Rogers J, Baliga P . Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation. Cardiovasc Intervent Radiol. 2002; 25(4):300-6. DOI: 10.1007/s00270-002-2614-5. View

15.

Alvarez D, Gerona S, Waisburg Z, Ciardullo M, de Santibanes E, Mastai R . Splanchnic hyperemia after liver transplantation in patients with end-stage liver disease. Liver Transpl Surg. 1998; 4(4):300-3. DOI: 10.1002/lt.500040403. View

16.

Jakab F, Sugar I, Rath Z, Nagy P, FALLER J . The relationship between portal venous and hepatic arterial blood flow. I. Experimental liver transplantation. HPB Surg. 1996; 10(1):21-6. PMC: 2423829. DOI: 10.1155/1996/90536. View

17.

Mogl M, Nussler N, Presser S, Podrabsky P, Denecke T, Grieser C . Evolving experience with prevention and treatment of splenic artery syndrome after orthotopic liver transplantation. Transpl Int. 2010; 23(8):831-41. DOI: 10.1111/j.1432-2277.2010.01062.x. View

18.

Nussler N, Settmacher U, Haase R, Stange B, Heise M, Neuhaus P . Diagnosis and treatment of arterial steal syndromes in liver transplant recipients. Liver Transpl. 2003; 9(6):596-602. DOI: 10.1053/jlts.2003.50080. View

19.

Kirbas I, Ulu E, Ozturk A, Coskun M, Harman A, Ogus E . Multidetector computed tomographic angiography findings of splenic artery steal syndrome in liver transplantation. Transplant Proc. 2007; 39(4):1178-80. DOI: 10.1016/j.transproceed.2007.02.024. View

20.

Ruf A, Dirchwolf M, Freeman R . From Child-Pugh to MELD score and beyond: Taking a walk down memory lane. Ann Hepatol. 2021; 27(1):100535. DOI: 10.1016/j.aohep.2021.100535. View