Splenic vein imaging and intervention procedure - digitalized window to remove background

This is an automatically translated article.

This article is professionally consulted by Master, Resident Doctor Tran Duc Tuan - Department of Diagnostic Imaging - Vinmec Central Park International General Hospital.
The procedure of splenic vein imaging and intervention - digitalized window erasing background is a modern method to help diagnose and treat by causing partial or complete occlusion of the veins of the splenic-portal system.

1. What is splenic vein scan and intervention?

The splenic vein imaging and intervention procedure - digitalization of background erasure is a minimally invasive percutaneous treatment that is performed by passing through the liver parenchyma (or sometimes the spleen parenchyma) to enter the system. splenic-portal venous system. Then, use substances to cause partial or complete embolism of the veins of the splenic - portal vein system
Pathologies that are indicated for splenic - portal vein imaging and intervention include: true varicose veins bronchi, portal vein cavernous hemangioma or portal vein right branch node before hepatectomy.

2. When to take and intervene splenic-portal vein?

Upper gastrointestinal bleeding due to ruptured esophageal varices. Portal hypertension Abnormal portal vein pathology. Preparing for right hepatectomy.

3. Contraindications of aortic intervention

Allergy to iodinated contrast media. End stage renal failure. Pregnant women. Thrombosis of the internal jugular vein, superior vena cava, or hepatic vein. Severe uncontrolled coagulopathy. Ascites of many degrees.

4. Prepare equipment and drugs before aortic surgery and imaging

Equipment and vehicles Digital background removal angiography (DSA). Dedicated electric pump Film, film printer, image storage system. Lead shirt, apron to shield X-rays. Medicines to prepare Local anesthetic. Pre-anesthesia and general anesthesia if indicated by the patient. Medicines to treat blood clotting disorders. Water-soluble iodine contrast agent. Antiseptic solution for skin and mucous membranes. Materials causing thrombosis Synthetic resin PVA. Bio-foam (gelfoam). Bio-glue (Histoacryl, Onyx...). Metal spirals of all sizes (Coils). Amplatzer vascular plugs.

5. Prepare the patient before aortic intervention

The patient was thoroughly explained about the procedure and procedure for splenic vein scan and intervention - digitalized window to erase the background and agreed to the procedure commitments before performing. Patients need to fast, fast for 6 hours before or can drink no more than 50ml of water. After entering the intervention room for imaging and intervention of the splenic vein - portal vein, the patient was lying on his back, vital signs were monitored such as: breathing rate, pulse, blood pressure, electrocardiogram, arterial blood gas by various types. machines. In case the patient is uncooperative or aggressive, a sedative will be prescribed. Disinfect the skin surface with an antiseptic solution and cover with a sterile towel with holes.

6. Splenic vein imaging and intervention procedure - digitized window to erase background

Open the way into the vascular lumen Local anesthesia. Micropuncture is used to poke through the skin into the liver parenchyma and into the portal vein system in the liver. In some special cases, it is possible to poke through the splenic parenchyma to enter the splenic vein. Insert the catheter into the portal vein system in the liver. Splenic-portal angiography Insert the Cobra catheter and guidewire into the main body of the portal vein or splenic vein Then replace the Cobra catheter with a Pigtail catheter or a 260mm multi-hole catheter . Withdraw the lead from the Pigtail tube and perform a background scan of the splenic-portal venous system through the Pigtail catheter. Embolization Procedure Thanks to a system of wires or microwires, the doctor will insert a catheter or microcatheter into the branch of the splenic vein - the portal that requires embolization. Selective embolization of this branch of the vein is done with the embolization materials described above. After embolization, DSA should be taken to check the circulation of the remaining blood vessels. End procedure of splenic vein intervention - portal Withdrawal of the entire system of catheters and leads. Withdraw the tube into the lumen. In order to minimize the complications of intra-abdominal bleeding at the site of puncture into the liver parenchyma, immediately after withdrawing the catheter into the lumen from the liver capsule, the doctor needs to block the terminal branch of the portal vein with a spiral system. Metals (Coils).

7. Evaluation of results after imaging and intervention of splenic-portal vein

The splenic vein scan and intervention procedure digitalized background erasure is considered successful based on the following criteria:
Partial or complete occlusion of selected venous branches with lesions of the splenic vein system -door. The remaining branches of the veins still have good circulation.

8. Complications and treatment direction after aortic intervention

Intra-abdominal bleeding The cause of this complication is either a laceration of the liver parenchyma or a rupture of the liver capsule at the site of the opening of the intrahepatic portal vein or by inadvertent injury to the intra-abdominal blood vessels during the procedure. performing splenic-portal vein intervention. Treatment:
If bleeding from the artery in the chest wall or the hepatic artery, perform a DSA and block the bleeding vessel. If bleeding from the portal vein branches can be treated medically, care and close monitoring. Bleeding in the biliary tract This is a mild complication that usually resolves on its own without treatment. The main cause is accidental injury to the intrahepatic biliary tract due to manipulations during splenic-portal vein intervention.
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