Ahmed Yousef Kandeel MD, PhD, Presenter: Nothing to Disclose

Ahmed Hilal, Abstract Co-Author: Nothing to Disclose

Adnan Al-shaikh, Abstract Co-Author: Nothing to Disclose

Ibrahim Alhefizi, Abstract Co-Author: Nothing to Disclose

To evaluate the role of percutaneous splenic embolization for the treatment of acute splenic sequestration and/or hypersplenism in children with Sickle Cell Disease (SCD)

Twenty two children (Age = 3-10 years)with SCD were enrolled in this prospective randumized study.Inclusion criteria were; two or more major attacks of acute splenic sequestration (n = 14) and/or evidence of hypersplenism (n=4). Complete splenic embolization was performed through a transfemoral approach in all patients. A 4 french catheter was used to inject poly-vinyl alcohol particles (355-710 u) into the intrasplenic arterial branches aiming to embolize more than 95% of the spleen. Serial CT scan of the upper abdomen done before embolization and at 2 weeks & 2,3,6 and 12 months after embolization was used for volumetric analysis of spleen. Complete blood picture was done before embolization and at day 1,3,7 and then monthly after embolization. Patient follow-up ranged between 3-27 (average 14 ) months.

Average procedure duration was 50 minutes with an average hospitalization period of 6.4 days. Average splenic volume before embolization was 510 CC (270-730 CC). Abdominal pain, low grade fever and minimal left pleural effusion were seen in all cases. Splenic abscess ,requring surgical interference, was seen in one (4.5%) patient. Serial CT scan showed three distinct phases of splenic volume changes after embolization. A first phase of mild (10-15%) increase of splenic volume developing after embolization up to day 14. A second phase of sudden and marked (up to 250%) increase of volume lasting untill the third month. A third and final phase of gradual and progressive reduction of splenic volume to less than 10 cc (less than 0.5%) by the 12th month. A stastically significant increase was noted in the RBCs count (P=0.018), haemoglobin level (P=0.032) and platelet count (P=0.012) after embolization. Sequestration attacks / hypersplenism were not recorded in any patient after embolization (P=0.0001).

Percutaneous splenic embolization is a minimally invasive and safe procedure that can be used as an alternative to surgical splenectomy for the treatment of children with SCD

A.Y.K.,A.Y.K.,A.H.,A.A.,I.A.,I.A.,I.A.,I.A.:

Kandeel, A, Hilal, A, Al-shaikh, A, Alhefizi, I, Splenic Embolizaion for the Treatment of Children with Sickle Cell Disease.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4412939.html