Preoperative splenic artery embolization for massive splenomegaly

Wu Z, Zhou J, Pankaj P, Peng B. Comparative treatment and literature review for laparoscopic splenectomy alone versus preoperative splenic artery embolization splenectomy. Surg Endosc. 2012 Oct;26(10):2758-66.

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Results: Preoperative splenic artery embolization plus laparoscopic splenectomy was successfully performed in all patients in group 1. One patient in group 2 required an intraoperative conversion to traditional open splenectomy because of severe blood loss. Compared with group 2, significantly shorter operating time, less intraoperative blood loss, and shorter postoperative hospital stay were noted in group 1. No marked significant differences in postoperative complications of either group were observed. Compared with group 3, group 1 had less intraoperative blood loss, shorter postoperative stay, and fewer complications. No significant differences were found in operating time. There was a marked increase in platelet count and white blood count in both groups during the follow-up period.

Conclusions: Preoperative splenic artery embolization with laparoscopic splenectomy reduced the operating time and decreased intraoperative blood loss when compared with laparoscopic splenectomy alone or open splenectomy. Splenic artery embolization is a useful intraoperative adjunctive procedure for patients with splenomegaly because of the benefit of perioperative outcomes.


Reso A, et al. Outcome of laparoscopic splenectomy with preoperative splenic artery embolization for massive splenomegaly. Surg Endosc. 2010 Aug;24(8):2008-12.

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Results: A total of 19 patients were identified. The median spleen length was 23 cm, and the median spleen weight was 1,740 g. Nine patients underwent LAS, and 10 underwent HALS. The median operative time was 130 min, and the median hospital stay was 6 days. There were no conversions to open laparotomy. The median estimated blood loss was 200 ml. One patient required reoperation 24 h after LAS due to bleeding, and PVT developed in three patients postoperatively.

Conclusions: In the setting of massive splenomegaly, LAS or HALS with preoperative SAE is safe and has a low conversion rate. Postoperative imaging surveillance for PVT should be performed routinely in this patient population.


Pandey SK, et al. Anatomical variations of the splenic artery and its clinical implications. Clin Anat. 2004 Sep;17(6):497-502.

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anatomy splenic artery

“The variations in origin, course, and terminal branching pattern of the splenic artery were studied in 320 cadavers. The artery originated from the coeliac trunk in the majority of cadavers (90.6%), followed by abdominal aorta (8.1%), and other sights (1.3%). A suprapancreatic course of the artery was commonly observed (74.1%) followed by enteropancreatic (18.5%), intrapancreatic (4.6%), and retropancreatic (2.8%) courses.

In two cases (0.63%) the proximal part of the splenic artery made a loop that was embedded in the substance of the pancreas, which is an interesting and rare finding. In five cases (1.5%) the proximal part of the artery divided into two or more branches that had suprapancreatic and enteropancreatic courses. The splenic artery divided into terminal branches in 311 (97%) cadavers. In nine (2.8%) cadavers it passed through the hilum of spleen without dividing. Two terminal branches were the most common (63.1%) followed by four (18.8%), six (9.7%), and more than six (5.6%) branches.

The present study clearly indicates that there is variation in origin, course, and terminal distribution pattern of the splenic artery. The knowledge of these variations are of significant importance during surgical and radiological procedure of upper abdominal region to avoid any catastrophic complications.”


More PubMed results on preop splenic artery embolization for massive splenomegaly and splenic arterial anatomy.

Splenic artery aneurysms: Comparing open and endovascular surgical modalities

Barrionuevo P, Malas MB, Nejim B, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg. 2019;70(5):1694–1699.

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“We included 33 case series of 523 splenic artery aneurysms treated with an endovascular approach and 22 series of 252 splenic artery aneurysms treated with open surgery. Short-term and long-term mortality rates were very low and not significantly different between the two interventions. Mortality was high for ruptured aneurysms treated with an open approach, with an event rate of 0.29 (95% CI, 0.04-0.71). End-organ infarction and gastrointestinal complications rates were not significantly different between the two approaches. The need for reintervention was lower for open surgery 0.00 (95% CI, 0.00-0.11) than for the endovascular approach 0.07 (95% CI, 0.01-0.17). The risk of access site complications for the endovascular approach was low at 0.02 (95% CI, 0.00-0.09). Rates of PES and coil migration were 0.38 (95% CI, 0.04-0.79) and 0.08 (95% CI, 0.00-0.24), respectively. Data were insufficient to identify a difference in mortality based on aneurysm size.”

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