017 - Disseminated Intravascular Coagulopathy After Splenic Artery Embolization: A New Complication
Morgan Sly, MD – Interventional Radiology Resident, Henry Ford Hospital; Peter Massa, MD – Interventional Radiologist, Henry Ford Hospital
Purpose: Splenic artery embolization is a relatively common and versatile procedure. It carries a host of well- known complications including splenic infarct, abscess, post-embolization syndrome, and coil embolization. Here we present a case of splenic artery embolization precipitating disseminated intravascular coagulopathy.
Material and Methods: An 82-year-old woman with a history of myelodysplastic syndrome presented for splenic artery embolization prior to splenectomy. Prior imaging findings were remarkable for a spleen measuring up to 30.4 cm. Proximal splenic artery embolization was performed via right femoral artery access utilizing a 12mm Amplatzer plug. Post embolization digital subtraction angiography showed occlusion of the proximal splenic artery with filling of the distal splenic artery and spleen via collaterals. The arteriotomy was closed with a closure device and the patient was admitted to the hospital in preparation for planned splenectomy the next day.
Results: The patient experienced mildly increased abdominal pain after embolization and later that evening became febrile. Laboratory values demonstrated elevated WBC counts with progressively decreasing hemoglobin and platelets. PT, PTT, and D-dimer were increased and fibrinogen was decreased which are all suggestive of DIC. The patient was transferred to the ICU and a thromboelastogram was performed leading to transfusion of 2 units pRBC, 1 unit cryoprecipitate, 3 units platelets, and 4 units of fresh frozen plasma. The patient underwent planned splenectomy on post-operative day 1 from splenic artery embolization. Hgb remained stable after transfusion and surgery, and platelets trended up over several days. The coagulopathy resolved within 48 hours of embolization.
Conclusions: Patients undergoing splenic artery embolization may be at small risk for transient DIC. We suspect this risk is increased in patients with massive splenomegaly and an underlying hematologic disorder. While the exact etiology of DIC after splenic artery embolization remains unknown, our patient was successfully managed with transfusion and DIC resolved after splenectomy.