Celiac arteriography following percutaneous splenoportography

Morfometric study of arterial branching of the spleen compared to radiological study

OBJECTIVE

To study the distribution of the branches of the splenic artery and relate it to the radiological study of its intraparenchymal distribution, aiming to use this knowledge in partial splenectomy.

METHODS

In the macroscopic study, we used 60 human spleens which the splenic artery dissected from its origin to observe the division and the terminal branches directed to the spleen. We measured the distance between the visceral surface of the spleen and the terminal division of the splenic artery and the emergence of the polar branches. In the radiological study, we used 30 human spleens in which contrast was injected in the splenic artery to perform an arteriography and study the terminal division and polar branches.

RESULTS

93.34% of the spleens showed bifurcation and terminal pattern of division and 6.66% trifurcation. We identified secondary and tertiary side branches, having a relative frequency of 10% for type I, 17% for type II and 8.33% for both. The distance between the visceral surface of the spleen and terminal division was on average 2.89 cm and the emergence of type I polar artery was 4.85 cm and 2.39 cm for type II. In the 30 arteriographies we assessed the terminal division and bifurcation was observed in 90% of spleens and trifurcation in 10%, and the presence of polar arteries in 16% type I and type II in 20%.

CONCLUSION

The splenic artery deisplays a bifurcation-type terminal division that can be viewed arteriographically. We highlight the existence of independent arterial segmentation in almost all cases (98%), similar in visceral and diaphragmatic surfaces of the spleen. Partial splenectomy is anatomical and the use of radiological methods becomes feasible in conservative treatment of splenic injuries.

Arterioportography

Arterioportography has superseded splenoportography which has given inadequate and at times misleading information. Eighty-two arterioportograms have been done in 78 patients with portal hypertension. The arterial phase may disclose malignancy, pancreatitis, diminished liver perfusion and the venous phase flow reduction, occlusion and the presence of thrombus. Arterioportography should provide evidence of suitability for specific shunts and features relevant to the performance of of a mesocaval or distal spleno-renal shunt are given in detail. An attempt is made to relate arterioportography and transhepatic portal catherisation into a combined function in the management of patients with portal hypertension.