Chaolun Li, Presenter: Nothing to Disclose

Weiping Wang MD, Abstract Co-Author: Nothing to Disclose

Eunice Kim Moon MD, Abstract Co-Author: Nothing to Disclose

John Fung, Abstract Co-Author: Nothing to Disclose

Koji Hashimoto MD, Abstract Co-Author: Nothing to Disclose

This retrospective study investigated the clinical presentations, diagnosis, and treatment of splenic steal syndrome (SSS) based on our one center experience.

From January 2007 to August 2013, the clinical data records of patients with SSS confirmed by angiography were reviewed. A total of 51 patients (40 men, 11 women, average age of 57.7±9.9 years, age range 27-76 years) were enrolled in this study. Patients with hepatic artery stenosis or celiac artery stenosis were exluded.

A whole liver graft was used in 49 patients, and split right lobe of liver was used in the other two patients. TIPS was performed in 4 patients before OLT. The onset time varies from 1 to 192 days (median 4days) after OLT. Forty-six patients (90.2%) presented this syndrome within 15 days after OLT. The most common clinical presentation is high resistance index and/or diastolic reversal flow in hepatic arteries detected by US, which was found in 35 patients. Persistent ascites was observed in 9 patients, in which 5 also presented high RI on US and another 1 had concomitant hyperbilirubinemia. Seven patients presented elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) and/or total bilirubin. Among the seven patients, five also presented high RI on US.  Forty-three patients with SSS showed high RI (RI > 0.8) 24 hr after OLT. RI of the SSS group ranged from 0.67 to 1.0, with mean of 0.94±0.08. All the patients were diagnosed by celiac angiography showing sluggish flow in hepatic artery and brisk flow in splenic artery without any mechanical cause of vascular obstruction. All the patients were treated with splenic artery embolization (SAE) after the diagnosis was confirmed. Proximal SAE was performed in 42 patients. Middle to distal SAE was performed in 9 patients. In the 14 patients embolized with coils, coils migrated to the hilum of spleen in 3 patients. Patients showed improved hepatic blood flow on both angiography immediate after SAE and US post treatment. One patient developed hepatic artery thrombosis one day after SAE. Biliary stent was placed in 7 patients after SAE.

Splenic steal syndrome occurs shortly after liver transplantation. Persistent high RI detected in hepatic artery may lead to the clinical suspision of this disease. It can be reversed by proximal SAE. 

Proximal SAE is an effective and safe method to treat SSS with very low rate of complication.

Li, C, Wang, W, Moon, E, Fung, J, Hashimoto, K, Experience of Diagnosis and Management of Splenic Steal Syndrome after Liver Transplantation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045699.html