Ahmadzade Mohadese, Akhlaghpoor Shahram, Rouientan Hamidreza, Hassanzadeh Sara, Ghorani Hamed, Heidari-Foroozan Mahsa, Fathi Mobina, Alemi Fakhroddin, Nouri Shadi, Trinh Kelly, Yamada Kei, Ghasemi-Rad Mohammad
Department of Radiology, Division of Vascular and Interventional Radiology, Baylor College of Medicine, Houston, Texas, Houston, USA.
Department of Interventional Radiology, Pardis Noor Medical Imaging and Cancer Center, Tehran, Iran, Tehran, Iran, Islamic Republic of.
Emerg Radiol. 2025 Feb;32(1):79-95. doi: 10.1007/s10140-024-02299-x. Epub 2024 Nov 22.
Splenic artery embolization (SAE) has emerged as a promising alternative for managing variceal bleeding secondary to portal hypertension (PH). This study aims to elucidate the significance of SAE in managing esophageal variceal bleeding in patients with PH, providing an overview of its efficacy, safety, and role in PH management.
A systematic review and meta-analysis were conducted in accordance with PRISMA standards. EMBASE, PubMed, Scopus, and Web of Science databases were searched from inception until April 14, 2024. Original observational and clinical studies on SAE in managing variceal bleeding due to PH were included. Meta-analyses were performed using a random-effects model, and publication bias was assessed using regression and rank correlation tests for funnel plot asymmetry.
Eighteen studies met the inclusion criteria, encompassing 531 patients. The meta-analysis revealed a significant reduction in variceal bleeding post-SAE (RD = -0.86; 95% CI: -0.97, -0.75; p < 0.001). Complete resolution of varices was observed in 26% of patients (95% CI: 11%, 45%; p = 0.006), and 78% showed improvement in variceal grade (95% CI: 43%, 88%; p < 0.001). SAE significantly increased platelet counts (SMD = 1.15; 95% CI: 0.63, 1.68; p < 0.001). Common complications included post-embolization syndrome, and the overall complication rate was low.
This systematic review and meta-analysis study supports the efficacy and safety of SAE in managing variceal bleeding due to PH, demonstrating significant reductions in bleeding, improvements in variceal grade, and increases in platelet counts.
脾动脉栓塞术（SAE）已成为治疗门静脉高压症（PH）继发静脉曲张出血的一种有前景的替代方法。本研究旨在阐明SAE在治疗PH患者食管静脉曲张出血中的意义，概述其疗效、安全性及在PH管理中的作用。
按照PRISMA标准进行系统评价和荟萃分析。检索EMBASE、PubMed、Scopus和Web of Science数据库，检索时间从数据库建立至2024年4月14日。纳入关于SAE治疗PH所致静脉曲张出血的原始观察性和临床研究。采用随机效应模型进行荟萃分析，并使用回归和秩相关检验评估漏斗图不对称性以评价发表偏倚。
18项研究符合纳入标准，共纳入531例患者。荟萃分析显示SAE术后静脉曲张出血显著减少（风险差=-0.86；95%可信区间：-0.97，-0.75；p<0.001）。26%的患者静脉曲张完全消失（95%可信区间：11%，45%；p=0.006），78%的患者静脉曲张分级改善（95%可信区间：43%،88%；p<0.001）。SAE显著增加血小板计数（标准化均数差=1.15；95%可信区间：0.63，1.68；p<0.001）。常见并发症包括栓塞后综合征，总体并发症发生率较低。
本系统评价和荟萃分析研究支持SAE治疗PH所致静脉曲张出血的有效性和安全性，表明出血显著减少、静脉曲张分级改善及血小板计数增加。
