Outcomes of splenic artery embolization in patients with portal hypertension: a single center experience

Background Cirrhotic (CPH) and non-cirrhotic portal hypertension (NCPH) can result in severe complications, including variceal bleeding, ascites, and hypersplenism. However, evidence regarding the long-term clinical impact of splenic artery embolization (SAE) in portal hypertension remains limited.Patients and methods We conducted a retrospective single-center study including consecutive patients who underwent SAE for complications of portal hypertension at Sahlgrenska University Hospital, Gothenburg, Sweden, between January 2016 and December 2024. Clinical, radiological, and laboratory data were collected at baseline and during follow-up. Overall survival, gastrointestinal bleeding, complications, and changes in clinical features of portal hypertension were evaluated.Results Twenty patients were included (median age 47 years; 60% male), with an equal distribution of CPH and NCPH. The most common indication for SAE was failure of endoscopic treatment for gastroesophageal varices (50%). SAE resulted in a significant reduction in spleen volume (1,325 vs. 1,146 mL, p = 0.024) and splenic vein diameter (14 vs. 12 mm, p = 0.008), while liver function remained stable. Complications occurred in 65% of patients, with post-embolization syndrome being the most frequent (45%). Patients with CPH showed a trend toward poorer overall survival (HR 4.94, 95% CI 0.57–42.7; p = 0.15) and a trend toward a higher risk of gastrointestinal bleeding after SAE (HR 8.02, 95% CI 0.96–66.8; p = 0.054) than those with NCPH.Conclusions SAE appears to be a feasible treatment option for portal hypertension-related complications in patients unsuitable for standard therapies, with more favorable outcomes in NCPH than CPH. Larger prospective studies are warranted to better define its role in clinical practice.