Carbon Dioxide Wedged Arterial Splenoportography: A New Technique – a Case Report and an Experimental Study

S.C.H. Yu & K.J. Cho



Background: Patients with splenic vein occlusion may present a diagnostic problem when the location, morphology, and cause of the obstructive lesion and the associated collateral veins cannot be clearly defined by standard diagnostic imaging modalities such as computed tomography, magnetic resonance venography, or indirect splenoportography (arterial portography).

Purpose: To evaluate the safety and effectiveness of carbon dioxide (CO2) wedged arterial splenoportography for definitive investigation of splenic vein occlusion.

Material and Methods: Following unsuccessful diagnosis with computed tomography and standard contrast arterial portography in a patient with recurrent gastric variceal bleeding, CO2 was injected into a wedged splenic arterial catheter and successfully outlined splenic vein occlusion and gastric varices. Our experience with this patient prompted us to perform an experimental study in swine to evaluate the safety and effectiveness of CO2 wedged arterial splenoportography for visualization of the splenic and portal veins. A microcatheter was advanced coaxially and wedged into the splenic arteries of three pigs. After checking the wedged positioning with contrast medium injection, CO2 was injected manually and the splenic region imaged. The spleens were then removed for gross and microscopic examinations.

Results: In the patient, CO2 wedged arterial splenoportography demonstrated gastric varices associated with splenic vein occlusion. In all animals, CO2 wedged arterial splenoportography visualized the splenic and portal veins. No CO2 extravasations occurred in the spleen. Gross and microscopic examinations revealed no evidence of splenic rupture or intrasplenic hematoma.

Conclusion: CO2 wedged arterial splenoportography may be a useful method for visualizing gastric varices associated with splenic vein occlusion. This new technique has the potential to replace the standard splenic arterial portography for visualization of splenic and portal veins, thus eliminating the need for injection of a large volume of iodinated contrast material. Further clinical studies are justified to evaluate this technique.