Schultz Gunnar, Naas Mohamed, Webb Jay
Radiology, Florida State University College of Medicine, Pensacola, USA.
Radiology, Florida State University College of Medicine, Tallahassee, USA.
Cureus. 2025 Aug 7;17(8):e89540. doi: 10.7759/cureus.89540. eCollection 2025 Aug.
Transjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established intervention for portal hypertension. However, some patients experience persistent complications such as encephalopathy, ascites, or thrombocytopenia, especially when further TIPS optimization is not technically possible. Partial splenic embolization (PSE), typically performed for hypersplenism or certain hematologic conditions, can reduce portal venous inflow and improve cytopenias; however, its use as an adjunct to TIPS is less well described. We present the case of a 73-year-old male with cirrhosis secondary to hepatitis C who developed recurrent ascites, worsening encephalopathy, and refractory thrombocytopenia following portal vein recanalization with TIPS placement 18 months prior. The patient's TIPS could not be further optimized due to technical limitations. Imaging demonstrated marked splenomegaly and an enlarged splenic artery, suggesting increased splenic contribution to portal inflow. PSE of the lower pole was performed. Post-procedure, the patient experienced significant clinical improvement. Encephalopathy episodes resolved, no ascites was seen on follow-up CT, and platelet count rose from <50,000/µL to >100,000//µL. The patient subsequently developed a splenic abscess requiring percutaneous intervention. PSE may serve as an effective adjuvant to TIPS in selected patients with persistent portal hypertension and cytopenias when further TIPS optimization is not possible. This case highlights the potential for PSE to reduce portal inflow and improve platelet count, suggesting an expanded role in the management of complex portal hypertension.
经颈静脉肝内门体分流术（TIPS）置入是一种成熟的门静脉高压治疗手段。然而，部分患者会出现诸如肝性脑病、腹水或血小板减少等持续性并发症，尤其是在技术上无法进一步优化TIPS时。部分脾栓塞术（PSE）通常用于治疗脾功能亢进或某些血液系统疾病，可减少门静脉血流并改善血细胞减少症；然而，其作为TIPS辅助治疗的应用描述较少。我们报告一例73岁男性患者，其因丙型肝炎继发肝硬化，在18个月前接受TIPS置入门静脉再通术后出现反复腹水、肝性脑病加重及难治性血小板减少症。由于技术限制，该患者的TIPS无法进一步优化。影像学检查显示脾脏明显肿大及脾动脉增粗，提示脾脏对门静脉血流的贡献增加。遂对脾下极进行了PSE。术后，患者临床症状显著改善。肝性脑病发作缓解，随访CT未见腹水，血小板计数从<50,000/µL升至>100,000/µL。该患者随后出现脾脓肿，需要进行经皮介入治疗。对于部分无法进一步优化TIPS的持续性门静脉高压和血细胞减少症患者，PSE可作为一种有效的TIPS辅助治疗方法。该病例突出了PSE减少门静脉血流和提高血小板计数的潜力，提示其在复杂门静脉高压管理中的作用可能扩大。
