Partial splenic embolization versus splenectomy for the management of autoimmune hemolytic anemia: A response.

I read with great interest the recent publication by Tanrıöver et al. on splenic artery embolization, in which they reached in conclusion that splenic artery embolization might be an option for hemolytic anemia as a bridging therapy to surgery or as an alternative therapy, especially in critically ill patients with disorders that contraindicate surgery [1]. Partial splenic embolization (PSE) is a non-surgical procedure developed to treat hypersplenism as a result of hepatic disease and thus avoid the disadvantages of splenectomy [2]. Furthermore, splenic artery emboli-sation has been used to treat various conditions, which include chronic idiopathic thrombocytopenic purpura, hereditary spherocytosis, and also splenic trauma in haemodynamically unstable patients. PSE provides a minimally invasive alternative to splenec-tomy in patients who are severely compromised because of splenomegaly or sequestration and destroying in the spleen. But, it should not be forgotten that this procedure is not innocent. There are severe numerous complications of this method such as post infarction syndrome (fever, left upper quadrant pain, risk of infection and abscess formation), and embolization are related to migration or inappropriate placement of embolic material [3,4]. These are the most dangerous and lethal complications of the procedure. One of the other serious potential complications associated with pulmonary disorders. Pneumonia, atelectasis, and pleural effusion, usually develop in the left lung and are associated with embolization of the upper pole of the spleen. Splenic abscesses, rupture of the spleen, and septicemia, have been previously reported after PSE [5]. Decreased portal-vein flow and a rapid increase in the platelet count after PSE may induce portal-vein thrombosis [2]. Moreover, the extent of embolization seems to be critical for longterm efficacy of PSE. Embolization of less than 50% of the splenic mass was almost always associated with a relapse of hypersplenism or continuation of splenic activity [5]. Splenectomy can safely be performed laparo-scopically in almost all cases of primary autoimmune