Abstract
Objective
This systematic review aims to elucidate the diagnostic capabilities of imaging techniques in identifying Non-Occlusive Hepatic Artery Hypoperfusion Syndrome (NOHAH) and to evaluate the efficacy and outcomes of splenic artery embolization (SAE), including the choice and placement of embolic agents.
Materials and methods
A comprehensive literature search was conducted using PubMed, CINAHL, and Scopus databases, adhering to PRISMA guidelines. Fifteen studies encompassing 240 patients treated with embolization (using coils or Amplatzer Vascular Plugs (AVP)) were analyzed. Key metrics assessed included patient demographics, embolization techniques, embolic agents, technical success, radiologic findings pre- and post-embolization, and complication rates.
Results
Among the 240 patients studied, 177 (73.8%) were reported by gender, with a majority being male (127/177, 71.7%). Doppler ultrasonography (DUS) emerged as the primary initial screening tool in 80% of studies. The hepatic arterial resistive index (RI) was a critical parameter, with mean values significantly decreasing from 0.84 pre-embolization to 0.70 post-embolization (p < 0.001). All cases confirmed technical success via digital subtraction angiography, revealing delayed hepatic arterial filling without stenosis or thrombosis. Coils were the predominant embolic agent, used in 80.8% of patients, followed by AVP in 16.3%. The overall mortality rate was 4.58%, with 29 major and 3 minor complications noted. Notably, proximal placement of coils in the splenic artery was associated with lower mortality rates compared to distal placement and showed comparable complication rates to AVPs.
Conclusion
DUS is a reliable screening modality for NOHAH, with post-SAE assessments showing significant improvements. The choice and location of embolization significantly impact patient outcomes, with proximal placement of coils emerging as a preferable strategy due to lower mortality rates and comparable complication profiles to alternative methods.
Similar content being viewed by others
References
Quintini C, Hirose K, Hashimoto K, et al. Splenic artery steal syndrome is a misnomer: The cause is portal hyperperfusion, not arterial siphon. Liver Transpl 2008; 14:374–379.
Uflacker R, Selby JB, Chavin K, et al. Transcatheter Splenic Artery Occlusion for Treatment ofSplenic Artery Steal Syndrome After Orthotopic LiverTransplantation CVIR 2002; 25:300–306.
Nüssler NC, Settmacher U, Haase R, et al. Diagnosis and treatment of arterial steal syndromes in liver transplant recipients. Liver Transpl 2003; 9:596–602.
Kirbas I, Ulu EMK, Ozturk A, et al. Multidetector Computed Tomographic Angiography Findings of Splenic Artery Steal Syndrome in Liver Transplantation. Transplant Proc 2007; 39:1178–1180.
Li H, Gao K, Huang Q, et al. Successful management of splenic artery steal syndrome with hepatic artery stenosis in an orthotopic liver transplant recipient. Ann Transplant 2014; 19:145–148.
Saad WEA. Nonocclusive Hepatic Artery Hypoperfusion Syndrome (Splenic Steal Syndrome) in Liver Transplant Recipients. Semin Intervent Radiol 2012; 29:140–146.
Durur Karakaya A, Çil BE, Kanmaz T, et al. Non-occlusive hepatic artery hypoperfusion syndrome and imaging findings: a systematic review. Abdom Radiol 2021; 46:2467–2473.
Pinto S, Reddy SN, Horrow MM, et al. Splenic artery syndrome after orthotopic liver transplantation: A review. Int J Surg 2014; 11:1228–1234.
Kim JH, Kim KW, Gwon DI, et al. Effect of Splenic Artery Embolization for Splenic Artery Steal Syndrome in Liver Transplant Recipients: Estimation at Computed Tomography Based on Changes in Caliber of Related Arteries. Transplant Proc 2011; 43:1790–1793.
Chao CP, Nguyen JH, Paz-Fumagalli R, et al. Splenic Embolization in Liver Transplant Recipients: Early Outcomes. Transplant Proc 2007; 39:3194–3198.
Li C, Quintini C, Hashimoto K, et al. Role of Doppler Sonography in Early Detection of Splenic Steal Syndrome. J Ultrasound Med 2016; 35:1393–1400.
Liu D-Y, Yi Z-J, Tang Y, et al. Three Case Reports of Splenic Artery Steal Syndrome After Liver Transplantation. Transplantat Proc 2015; 47:2939–2943.
Mogl MT, Nüssler NC, Presser SJ, et al. Evolving experience with prevention and treatment of splenic artery syndrome after orthotopic liver transplantation. Transpl Int 2010; 23:831–841.
Saad WE, Anderson CL, Kowarschik M, et al. Quantifying Increased Hepatic Arterial Flow With Test Balloon Occlusion of the Splenic Artery in Liver Transplant Recipients With Suspected Splenic Steal Syndrome: Quantitative Digitally Subtracted Angiography Correlation With Arterial Doppler Parameters. Vasc Endovascular Surg 2012; 46:384–392.
Teegen EM, Denecke T, Schmuck RB, et al. Impact of Doppler Ultrasound on Diagnosis and Therapy Control of Lienalis Steal Syndrome After Liver Transplantation. Ann Transplant 2017; 22:440–445.
Zhu X, Tam MDBS, Pierce G, et al. Utility of the Amplatzer Vascular Plug in Splenic Artery Embolization: A Comparison Study with Conventional Coil Technique. Cardiovasc Intervent Radiol 2011; 34:522–531.
Zhu X-S, Gao Y-H, Wang S-S, et al. Contrast-enhanced ultrasound diagnosis of splenic artery steal syndrome after orthotopic liver transplantation. Liver Transpl 2012; 18:966–971.
Sevmis S, Boyvat F, Aytekin C, et al. Arterial Steal Syndrome After Orthotopic Liver Transplantation. Transplant Proc 2006; 38:3651–3655.
Uslu N, Aslan H, Tore HG, et al. Doppler ultrasonography findings of splenic arterial steal syndrome after liver transplant. Exp Clin Transplant 2012; 10:363–367.
Maurer MH, Mogl MT, Podrabsky P, et al. Splenic Artery Syndrome After Orthotopic Liver Transplantation: Treatment with the Amplatzer Vascular Plug. Cardiovasc Intervent Radiol 2011; 34:1208–1213.
Manner M, Otto G, Senninger N, et al. Arterial steal: an unusual cause for hepatic hypoperfusion after liver transplantation. Transpl Int 1991; 4:122–124.
Langer R, Langer M, Scholz A, et al. The splenic steal syndrome and the gastroduodenal steal syndrome in patients before and after liver transplantation. Aktuelle Radiol 1992; 2:55–58
Bárcena R, Moreno A, Foruny JR, et al. Improved graft function in liver-transplanted patients after partial splenic embolization: reversal of splenic artery steal syndrome? Clin Transplant 2006; 20:517–523.
Li C, Kapoor B, Moon E, et al. Current understanding and management of splenic steal syndrome after liver transplant: A systematic review. Transplant Rev (Orlando) 2017; 31:188–192.
Hom BK, Shrestha R, Palmer SL, et al. Prospective evaluation of vascular complications after liver transplantation: comparison of conventional and microbubble contrast-enhanced US. Radiology 2006; 241:267–274.
García-Criado Á, Gilabert R, Bianchi L, et al. Impact of contrast-enhanced ultrasound in the study of hepatic artery hypoperfusion shortly after liver transplantation: contribution to the diagnosis of artery steal syndrome. Eur Radiol 2015; 25:196–202.
Guan Y-S, Hu Y. Clinical Application of Partial Splenic Embolization. ScientificWorldJournal 2014; 961345.
Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol 2014; 6:160–168.
L. D, L D, Diogo D, et al. Splenic Artery Syndrome After Liver Transplantation - Predictive Factors Experience of a Center. Rev Port Cir 2021; 50:43–49.
Saad WEA. Management of Nonocclusive Hepatic Artery Complications After Liver Transplantation. Tech Vasc Interv Radiol 2007; 10:221–232.
Fleckenstein FN, Luedemann WM, Kücükkaya A, et al. Splenic artery steal syndrome in patients with orthotopic liver transplant: Where to embolize the splenic artery? PLOS ONE 2022; 3:e0263832.
Funding
This study was not supported by any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed Consent
For this type of study consent for publication is not required.
Competing interests
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Torkian, P., Moghadam, A.D., Zimmerman, J. et al. A systematic review of diagnostic and interventional techniques in non-occlusive hepatic artery hypoperfusion syndrome. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04340-6
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00261-024-04340-6