Partial splenic embolization with Glubran ？ 2/Lipiodol ？ mixture for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy

Thrombocytopenia related to hypersplenism is seen in a variety of clinical settings, the most common being portal hypertension and splenomegaly due to cirrhosis (1,2). Thrombocytopenia of hypersplenism, defined as a platelet count below 75×109/L, is predominantly caused by increased splenic sequestration or the destruction of platelets (1). In oncological patients, hypersplenism can occur as a result of hepatic injury secondary to chemotherapy drugs, and thrombocytopenia can preclude or limit administration of systemic therapy (2-5). Platelet transfusion, which remains the most effective method of correcting thrombocytopenia, has temporary and limited effects in patients with an increase in platelet sequestration and destruction (6,7). Then, splenectomy is often considered as a last resort to treat refractory thrombocytopenia. However, surgical treatment is risky and often times contra-indicated in such poor candidates (8,9). Over the past 2 decades, partial splenic embolization (PSE) has been used to safely palliate the effects of hypersplenism by reducing the volume of splenic parenchyma (2-6). Although the efficacy of PSE for relieving thrombocytopenia is well-established, the optimal embolic agent to be used remains to determine (10-14). Various embolic materials have been used for PSE, including temporary agents such as absorbable gelatin sponge particles and permanent agents such as calibrated microspheres. All of these agents, however, are associated with a severe postembolization syndrome that often persists over 1 week. Liquid embolic agents, especially cyanoacrylates, may be very useful in such a setting, thanks to their properties (15). N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS; Glubran？2; GEM Srl, Viareggio, Italy) is a well-known glue comprising a proprietary comonomer, making the glue more stable. This is the only glue approved by the European Community for internal human use. This synthetically derived glue shows rapid polymerization (1–5 s), but complete sealing occurs in approximately 5 min. The use of Lipiodol？ (Guerbet, Aulnay-sous-Bois, France) is mandatory to make the glue radiopaque and modulate the delay of polymerization. To our knowledge, the use of glue in such a setting has not been reported