Hypersplenism (portal HTN, hereditary spherocytosis) or other cause of thrombocytopenia (e,g, ITP and chemotherapy)
Variceal bleeding particularly gastric without adequate access for transvenous obliteration.

For gastric variceal bleeding - 80% reduction in variceal bleeding episodes in available small studies
For cytopenia - 2xs baseline in 2 months. Rise is proportional to amount of spleen embolized.

CMP, CBC, and INR/PT

General recommendation to start broad spectrum antibiotics before and continue 1-2 weeks after with aggressive pain control

Helpful to have a CE CT if available to get a sense of the vascular anatomy.

Arterial access, often CFA with 4/5 Fr sheath but can do radial or others as needed.
Select the splenic artery with curved catheter (e.g. C2, Sim, Sos).
Perform angiography to map out anatomy.
Advance microwire/microcatheter system as needed for more distal catheterization.
Embolization
- Traditionally done with particles (300-500 or 500-700 um) for thrombocytopenia targeting infarction of 50-70% of the spleen. Ideally the lower pole is targeted to decreased some complications such as left pleural effusion.
- More proximal coil embolization of the splenic artery has also been described for embolization for variceal bleeding. This may be superior as it decreases perfusion and thus variceal blood flow while avoiding complications such as infection risk with infarction of the spleen.
Post-embolization angiography to confirm adequate treatment.
Remove catheter/sheath and achieve hemostasis.

Post-embolization syndrome in ~100%.
Left pleural effusion, atelectasis, and pneumonia.
Portal vein thrombosis.
Rare (1%) death, often associated with splenic abscess or other infection.
More complications with larger infarct volume and patients with Child-Pugh C cirrhosis.

Partial Splenic Embolization