SAFE PARTIAL EMBOLIZATION OF THE SPLENIC ARTERY IN ACCORDANCE TO ITS LAST PANCREATIC BRANCH

Splenectomy was a widely used procedure for treatment of some diseases like hypersplenism. thalassemia major. Hodgkin disease, ect.... (Poulin et aI., 1998). Moreover. it was commonly considered as a life saving technique in traumatic splenic hemorrhage and hemorrhage resulting from portal hypertension (Mishin and Ghidirim, 2004). However, nonsurgical
management was favored because of morbidity related to laparotomy and splenectomy (Bader et aI., 2001). Therefore. Han et al. (1997), Sackrider et al. (2001) and Wahl et al. (2004) thought that splenic artery embolization could be performed preoperatively or as an alternative to surgery to obtain partial or total organ ablation. However, Inagawa et al.
(2004) pointed out that in every embolization procedure, inadvertent passage of embolic material to the vessels of non-target organs was the most dangerous complication. In splenic artery embolization, this complication may occur in one or more of the pancreatic branches of the splenic artery causing pancreatitis (Rose et aI., 1998). The left part and the tail of the pancreas are specifically concerned with this complication as the splenic artery is the only source of its arterial supply (Pandey et aI., 2004). Although the embolic material may involve the gastric branches of the splenic artery, yet the extensive anastomosis and collateralization between short gastric and left gastroepiploic arteries with the rest of gastric arterial supply assure sufficient blood supply to the stomach (Vandamme and Bonte, 1988) Consequently, Harned et at, (1998) and Kimura et al. ( 2003) preferred the selective or partial splenic embolization where one or two branches of the splenic artery were involved, especially where a false aneurysm or frank extravasation could be shown to arise from a discrete source. This could be explained by Palsson et al, (2003) who assumed that partial embolization reduced the incidence of complications following splenic artery embolization, which included splenic infarction. rupture. abscess,
sepsis and inadvertent non-target embolization. This latter complication was particularly recorded in the pancreas with high incidence of pancreatitis. Obviously, to avoid this potentially life-threatening complication, an attempt knowledge of the vascular anatomy of the splenic artery and its branches is required. Of particular importance is the exact anatonucal ort-  gin of the last pancreatic branch from the splenic artery, since the tip of the microcatheter should be distal to this origin to achieve a safe embolization to the splenic artery.