To evaluate the application of preoperative preventive splenic artery embolization (PSAE) in splenectomy for left portal hypertension.

Clinical data of 1 patient with left portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Anhui Medical University in March 2025 were analyzed retrospectively. The 47-year-old male patient was hospitalized due to "recurrent epigastric pain for more than 10 years". Physical examination showed abdominal distension, evident tender in the upper abdomen, accompanied with muscle tension and rebound pain, shifting dullness (+) and weak bowel sounds. Laboratory examination revealed WBC was 2.1×10⁹/L, RBC 5.78×10¹²/L, Hb 169 g/L, Plt 42×10⁹/L, ALT 12.0 U/L, AST 18.4 U/L, TB 15.57 μmol/L, DB 3.88 μmol/L and ALB 45.8 g/L, respectively. CT scan showed enlargement of the spleen, embolism or stenosis of splenic vein. Endoscopic examination revealed isolated varices of the gastric fundus in tortuosity and earthworm shape. The initial diagnosis was left portal hypertension. After active preoperative preparations, PSAE was performed on March 25, 2025. The right femoral artery puncture was performed using Seldinger technique. Superselective catheterization of the main splenic artery was conducted using the microcatheter. The left portal hypertension patients were subject to staged embolization to limit blood flow, followed by complete embolization of the main splenic artery by using tissue glue and iodized oil in a ratio of 1∶2. Splenectomy was performed on March 26, 2025.

At postoperative 3 d, CT scan showed that isolated varices of the gastric fundus were significantly alleviated and original tortuous and thickened venous masses were absent, confirming that splenectomy effectively relieved regional portal hypertension. DSA during follow-up showed that the splenic artery trunk was completely occluded and no evident collateral circulation was established. Postoperative pathological examination showed that the resected spleen was significantly enlarged, weighing 850 g, and the capsule was thickened and the tension was increased. The section was dark red with tough texture, presenting with extensive fibrotic changes. Postoperative Plt was increased from 42×10⁹/L before operation to 210×10⁹/L, WBC was increased from 2.1×10⁹/L to 6.5×10⁹/L, and hypersplenism was completely treated. No postoperative complications, such as bleeding and infection, were reported. The patient was recovered well and discharged at postoperative 7 d.

PSAE can block the blood flow of splenic artery by preoperative intervention, reduce the risk of bleeding during splenectomy, decrease the size of spleen and improve the exposure of surgical field. PSAE can also adjust the hemodynamic stability of portal vein system, especially suitable for patients with pancreatic or splenic vein obstruction-induced portal hypertension.