Bicuspid and tricuspid aortic valve do not have the same ascending aorta morphology.

Bicuspid aortic valves are associated with histopathological abnormalities of the aorta. Their diameters have been measured in several studies, but the literature concerning changes in the overall anatomy of the ascending aorta is limited. We wanted to know whether the anatomy of the valve, bicuspid or tricuspid, is associated with anatomical differences. We prospectively included patients requiring aortic valve surgery. The protocol included a chest CT scan before the operation to determine the angulations and straight lengths of aortic segments 0 and 1. All of the patients underwent surgery to assess their aortic valve morphology. We included 107 patients, 25 (23%) with bicuspid diagnostic valves and 82 (77%) with tricuspid ones. Most angulations were similar between the groups. However, the angle between the ring and the plane of the top of the commissures of the semilunar cusps was lower in bicuspid than tricuspid aortic valves. The straight lengths in the aortic root did not differ significantly, but the lengths separating these planes from the BCAT plane were consistently greater in the bicuspid group. The angle between the ring plane and the patient's vertical axis was lower in the bicuspid, the plane of the ring being verticalized in this group. In conclusion, we were able to confirm significant morphological differences in addition to the diameters. However, this study does not establish causal relationships among valve morphology, ascending aortic morphology, histology, and possibly associated pathologies. An extremely large cohort will be required indicate such causal connections. Clin. Anat. 31:693-697, 2018. © 2018 Wiley Periodicals, Inc.

The apex of the aortic arch backshifts with aging.

BACKGROUND: Only a few studies, involving small numbers of patients, have globally assessed the curvature of the thoracic aorta but without any details concerning the location of the supra-aortic trunks. OBJECTIVES: Using CT to describe normal aortic-arch morphology and its changes with age and sex. METHODS: 344 CT scans were studied. We measured the distances from the apex to the ascending and descending aorta, the curvilinear length of the entire arch, that of the segment, including bifurcations of supra-aortic vessels, and the angle, height, and shift of the arch. RESULTS: In men, the arch was significantly longer (146.2 vs 122.8 mm; p < 0.001), higher (49.3 vs 40.1 mm, p < 0.001), and wider transversely (83.6 vs 73.3 mm; p < 0.001) than in women. The average men's arch also had a more acute angle at the apex (79.7° vs 83.7° p < 0.001). Neither morphology nor age influenced the winding angle around the mediastinum. Aging was accompanied by deflection and extension of the aortic arch, which grew more anteroposteriorly (6.1 mm/10 years in men) than vertically (2.5 mm/10 years in men), while the apex moved towards the rear of the arch. The ascending aorta was the only curvilinear length unaffected by age, whereas the supra-aortic trunks parted from each other. CONCLUSION: We believe that all these original observations could lead to a better assessment of normal aging of the aorta and guide technical choices during surgical or hybrid procedures.

[Impact of HPV status on nutritional status during radio chemotherapy for oropharyngeal cancer]. / Impact du statut HPV sur l'évolution nutritionnelle au cours de la chimioradiothérapie des patients atteints d'un cancer de l'oropharynx.

PURPOSE: Patients with oropharyngeal cancer are at high nutritional risk before and during treatment. Little is known about the influence of human papillomavirus (HPV) infection on nutritional status and its evolution during treatment. MATERIALS AND METHODS: A single-center retrospective study was conducted between August 2017 and December 2020 including 48 patients (14 HPV-induced: HPV+ and 34 non-HPV-induced: HPV-) with oropharyngeal squamous cell carcinoma treated by radiotherapy±chemotherapy (RT/CT). Nutritional risk at the time of tumor assessment (TA) was assessed by weight loss, swallowing ability, and the presence of digestive disorders in 4 stages of increasing severity. Nutritional status was assessed by weight and nutrition risk index (NRI) at the time of TA, before the start and at 3 months from the end of RT±CT. During RT±CT, the NRI and the systemic inflammatory response index (SIRI=neutrophils * monocytes/lymphocytes) were assessed weekly. RESULTS: HPV+patients were at lower nutritional risk at TA (50% grade ≥2 vs 85%, P=0.02), lost more weight (6% of their body weight vs 3%, P=0.05), and increased their SIRI by 7.5 points more than HPV- patients (P=0.04) during RT/CT. CONCLUSION: HPV+ oropharyngeal cancer patients are at high nutritional risk even in the absence of undernutrition at the outset of management.

Thoracic sarcopenia as a predictive factor of SARS-COV2 evolution.

PURPOSE: Evaluation of CT sarcopenia as a predictor of intensive care hospitalization during SARS-COV2 infection. MATERIALS AND METHODS: Single-center retrospective study of patients admitted to hospital with SARS-COV2 infection. The estimation of muscle mass (skeletal muscle index (SMI)) for sarcopenia, measurement of muscle density for muscle quality and body adiposity, were based on CT views on the T4 and L3 levels measured at admission. Demographic data, percentage of pulmonary parenchymal involvement as well as the orientation of patients during hospitalization and the risk of hospitalization in intensive care were collected. RESULTS: A total of 162 patients hospitalized for SARS-COV2 infection were included (92 men and 70 women, with an average age of 64.6 years and an average BMI of 27.4). The muscle area measured at the level of L3 was significantly associated with the patient's unfavorable evolution (124.4cm2 [97; 147] vs 141.5 cm2 [108; 173]) (p = 0.007), as was a lowered SMI (p < 0.001) and the muscle area measured in T4 (OR = 0.98 [0.97; 0.99]), (p = 0.026). Finally, an abdominal visceral fat area measured at the level of L3 was also associated with a risk of hospitalization in intensive care (249.4cm2 [173; 313] vs 147.5cm2 [93.1; 228] (p < 0.001). CONCLUSION: This study demonstrates that thoracic and abdominal sarcopenia are independently associated with an increased risk of hospitalization in an intensive care unit, suggesting the need to assess sarcopenia on admission during SARS-COV2 infection.

[Preventive and emergency embolization of angiomyolipomas: our experience]. / Embolisation préventive et en urgence des angiomyolipomes: notre expérience.

AIM: To present our experience with emergency or programmed embolization of angiomyolipomas. PATIENTS AND METHODS: The retrospective study 1999-2000 included a total of 20 patients with AML, five of whom had hypothyroidism. Group I emergency embolization: 11 patients age being 61.4 ± 15.6 years and the size of AML 8.2 ± 2.8 cm presented retroperitoneal hemorrhage from spontaneous rupture. Two had a hemorrhagic shock. A transfusion of 3.4 blood units per patient was performed for five patients. A clinical and radiological follow-up was done by scanning during the first week and in one month. Group II preventive embolization: nine patients, with age between 58.3 ± 15.2 years and tumor size 5.2 ± 2.2 cm, all asymptomatic. All successfully received a unilateral preventive embolization. A scan was performed one month later. RESULTS: Group I: the embolization was effective in 100% of patients. No intraoperative incident was reported. After one month, the reduction in tumor volume was 40%. At eight months, a patient underwent nephrectomy because of a new fracture, and another a second embolization after 14 months. The technical result was maintained in 83% of cases after 18 months. Two patients developed HTA after embolization controlled by a single treatment, and five had limited renal ischemic sequels. Group II: no intraoperative incidents and no postoperatively complications have been reported. One month after embolization, the reduction in tumor volume was 23%. After 24 months, patients remained completely asymptomatic, no spontaneous bleeding has been reported, no surgery has been performed, and no HTA has been described. Only one re-embolization was done at 20 months (artery duplicity). Limited renal ischemic sequels were reported for one patient but no renal failure. CONCLUSIONS: The required embolization became the method of choice in emergency with excellent results and few complications at distance. Programmed embolization effectively prevented the risk of bleeding, without impact on the renal function, with a low economic cost compared to hospitalization and emergency care. The significance of the observed AML--hypothyroidism association in our series requires a confrontation with more important cohorts.

[CT and MR imaging follow-up of medically treated acute aortic syndrome]. / Comment je surveille un syndrome aortique aigu traité médicalement au scanner ou en IRM?

The follow-up of medically treated acute aortic syndromes relies on CT and MR imaging. Comparison with prior examinations is essential. For aortic dissections, progressive enlargement of the false lumen, visceral hypoperfusion, and extension should be excluded. Mural hematomas and ulcers also undergo close follow-up to detect progression and recanalization. It is important to be familiar with the risk factors of disease progression for medically treated acute aortic syndromes and their management. It is also important to be familiar with the imaging features of disease progression. Acute aortic syndromes managed medically should undergo routine follow-up with CT or MR because these lesions may evolve silently over time and present with complications.

Nodular reverse halo sign in active pulmonary tuberculosis: A rare CT feature?

PURPOSE: The purpose of this study was to investigate the prevalence of the nodular reverse halo sign (NRHS) in chest computed tomography (CT) in patients with active pulmonary tuberculosis. MATERIALS AND METHODS: From March 2018 to March 2019, 29 consecutive patients with a culture-confirmed active pulmonary tuberculosis and who underwent chest CT examination during hospital-admission were retrospectively included in the study. There were 24 men and 5 women with a mean age of 40.9±16.7 (SD) years (range: 18-80years). Chest CT examinations of included patients were evaluated for the presence of NRHS and other tuberculosis-related CT signs. RESULTS: CT revealed the NRHS in 5 patients (5/29; 17%). The other CT signs of tuberculosis included consolidations in 18 patients (18/29; 62%), tree-in-bud pattern in 14 patients (14/29; 48%), cavitation in 12 patients (12/29; 41%), sparse nodules in 10 patients (10/29; 34%), and pleural effusion in 8 patients (8/29; 28%). CONCLUSION: CT shows NRHS in 17% of patients with active pulmonary tuberculosis, indicating that the sign is not as rare as previously thought in patients with this condition.

Online monitoring of volatile organic compounds emitted from human bronchial epithelial cells as markers for oxidative stress.

Particulate air pollution is associated with adverse respiratory effects and is a major factor for premature deaths.In-vitroassays are commonly used for investigating the direct cytotoxicity and inflammatory impacts due to particulate matter (PM) exposure. However, biological tests are often labor-intensive, destructive and limited to endpoints measured offline at single time points, making it impossible to observe the progression of cell response upon exposure. Here we explored the potential of a high-resolution proton transfer reaction mass spectrometer (PTR-MS) to detect the volatile organic compounds (VOCs) emitted by human bronchial epithelial cells (BEAS-2B) upon exposure to PM. Cells were exposed to single components (1,4-naphthoquinone and Cu(II)) known to induce oxidative stress. We also tested filter extracts of aerosols generated in a smog chamber, including fresh and aged wood burning emissions, as well asα-pinene secondary organic aerosol (SOA). We found that 1,4-naphthoquinone was rapidly internalized by the cells. Exposing cells to each of these samples induced the emission of VOCs, which we tentatively assigned to acetonitrile, benzaldehyde and dimethylbenzaldehyde, respectively. Emission rates upon exposure to fresh and aged OA fromα-pinene oxidation and from biomass burning significantly exceeded those observed after exposure to similar doses of Cu(II), a proxy for transition metals with high oxidative potential. Emission rates of biomarkers from cell exposure toα-pinene SOA exhibited a statistically significant, but weak dose dependence. The emission rates of benzaldehyde scaled with cell death, estimated by measuring the apical release of cytosolic lactate dehydrogenase. Particle mass doses delivered to the BEAS-2B cells match those deposited in the human tracheobronchial tract after several hours of inhalation at elevated ambient air pollution. The results presented here show that our method has the potential to determine biomarkers of PM induced pulmonary damage in toxicological and epidemiological research on air pollution.

Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology (SFC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) on magnetic resonance imaging in patients with cardiac electronic implantable devices.

Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.

Three artificial intelligence data challenges based on CT and MRI.

PURPOSE: The second edition of the artificial intelligence (AI) data challenge was organized by the French Society of Radiology with the aim to: (i), work on relevant public health issues; (ii), build large, multicentre, high quality databases; and (iii), include three-dimensional (3D) information and prognostic questions. MATERIALS AND METHODS: Relevant clinical questions were proposed by French subspecialty colleges of radiology. Their feasibility was assessed by experts in the field of AI. A dedicated platform was set up for inclusion centers to safely upload their anonymized examinations in compliance with general data protection regulation. The quality of the database was checked by experts weekly with annotations performed by radiologists. Multidisciplinary teams competed between September 11th and October 13th 2019. RESULTS: Three questions were selected using different imaging and evaluation modalities, including: pulmonary nodule detection and classification from 3D computed tomography (CT), prediction of expanded disability status scale in multiple sclerosis using 3D magnetic resonance imaging (MRI) and segmentation of muscular surface for sarcopenia estimation from two-dimensional CT. A total of 4347 examinations were gathered of which only 6% were excluded. Three independent databases from 24 individual centers were created. A total of 143 participants were split into 20 multidisciplinary teams. CONCLUSION: Three data challenges with over 1200 general data protection regulation compliant CT or MRI examinations each were organized. Future challenges should be made with more complex situations combining histopathological or genetic information to resemble real life situations faced by radiologists in routine practice.

Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study.

To evaluate long-term effects of arterial embolization (AE) for postpartum hemorrhage (PPH) on menses recovery and subsequent pregnancies. One hundred thirteen consecutive patients, recruited from 1999 to 2006, who had undergone AE for severe PPH were evaluated in a retrospective monocentric study. As embolization agents, pledgets of absorbable gelatine sponge (Curaspon) were used in 106 cases, Curaspon powder in 3 cases, and inert microparticles in 4 cases. In 111/113 cases (98.1%), AE was successful in controlling PPH. In two cases (1.7%), the AE was unsuccessful and required a total abdominal postembolization hysterectomy. Concerning fertility, 6 patients were lost to follow-up and 107 were available. The average time to follow-up was 46.4+/-21.8 months. Of the 107 patients, 99 had recovery of menses (92.5%). Of the 107 (61%) patients, 66 reported regular menstruation with normal delay after the delivery. Thirty-three patients (31%) reported subjective changes in the frequency and amount of menses. Six patients (5.6%) had documented amenorrhea after AE and developed diffuse uterine synechiae at the hysteroscopic investigation. Out of 29 patients who desired and attempted conception, 18 patients (62%) reported a total of 19 pregnancies at the end of the follow-up. One miscarriage at 12 weeks of gestation was reported. The 18 pregnancies at term were uneventful until delivery, but 3 cases of further PPH (15%) occurred due to abnormal placentation requiring a further AE. All full-term newborns were healthy. AE is a feasible, safe, and reproducible technique to control PPH, allowing a very high resumption of menses and subsequent pregnancies; in these cases, considering the elevated incidence of further PPH due to abnormal placentation, an accurate ultrasonographic monitoring during pregnancy seems appropriate.

[Role of endovascular treatment of symptomatic splanchnic artery stenoses in HIV patients: report of three cases]. / Place du traitement endovasculaire des sténoses symptomatiques d'artères digestives chez les sujets infectés par le VIH: trois cas.

Patients with HIV or AIDS frequently present with GI symptoms, sometimes due to early and diffuse atherosclerosis. We report 3 cases of HIV patients with abdominal pain due to severe splanchnic arterial stenosis. Only one patient presented typical clinical findings of mesenteric ischemic. Endovascular treatment was performed in all three cases. Good clinical outcome was immediate in 2 cases. In the third case, subsequent bowel resection was required due to irreversible ischemic injury in spite of local thrombolysis and endovascular revascularization in a patient presenting with acute severe mesenteric ischemia. In all three cases, vascular patency was demonstrated at follow-up. Mesenteric ischemia is a severe complication requiring early diagnosis in HIV patients, especially those with vascular risk factors, especially since endovascular treatment is a valid therapeutic option.

[Endovascular treatment of SVC syndrome from neoplastic origin: a review of 34 cases]. / Traitement endovasculaire du syndrome cave supérieur d'origine néoplasique: à propos de 34 patients.

PURPOSE: To report our experience with the treatment of 34 patients with SVC syndrome from neoplastic origin using the Wallstent. MATERIALS AND METHODS: Thirty-four patients were treated between January 2000 and February 2007: 21 males and 13 females, aged 44-81 years, with non-small-cell lung carcinoma in 27 cases (79%), small-cell lung carcinoma in 5 cases (15%) and metastatic breast adenocarcinoma to the mediastinum in 2 cases (6%). All patients were treated using the stainless steel self-expanding Wallstent. A dual brachial-femoral access was used in all cases. RESULTS: Stent placement was possible in all cases. Per procedure acute respiratory distress occurred in 2 cases: 1 case of acute pulmonary edema and 1 case of tamponade. Symptoms resolved within 24 hours. Twenty-six patients died from disease progression, 8 during the first month, and 16 within 32-545 days post-procedure (mean: 213.4 days). Five patients with recurrent SVC syndrome underwent repeat treatment (restenosis in 3 cases, fracture in 1 case, thrombosis in 1 case), for primary and secondary patency rates of 81% and 100%. CONCLUSION: Palliative stent treatment of neoplastic SVC syndrome is reliable, safe and provides long-standing improvement in quality of life.

[Type III endoleaks at follow-up of covered descending thoracic aortic stent-grafts: report of 3 patients]. / Endofuites de type III au cours du suivi d'endoprothèses couvertes aortiques thoraciques descendantes: 3 patients.

PURPOSE: To describe the imaging work-up and management of type III endoleaks detected after covered stent-graft treatment of descending thoracic aortic aneurysms. PATIENTS AND METHODS: Retrospective study of circumstances surrounding the diagnosis, management and outcome type III endoleaks occuring in 3 of 18 patients following covered stent-graft treatment of descending thoracic aortic aneurysms between April 1998 and July 2005. The endoleaks were detected at a mean follow-up of 22 months (19-24 months) after stent-graft placement. RESULTS: The type III endoleaks were detected on scheduled follow-up CT examinations in asymptomatic patients. Endovascular management was proposed at a mean interval time of 4.4 months (1 week - 11 months) after diagnosis of the endoleak, and was successful in all 3 cases. One patient died 1 month after endovascular repeai of the leak, 1 patient required surgical management at 14 months for new recurrence, and 1 patient had a favorable outcome at 2 months. CONCLUSION: Follow-up of patients after covered stent-graft treatment of descending thoracic aortic aneurysms is required. Prompt endovascular repair of delayed complications may be possible, but surgical management may become necessary.

Aortic stent-grafts: Endoleak surveillance.

Endoleaks have been referred to as the "Achilles heel" of endovascular aortic aneurysm repair (EVAR) and are the most common complication of this procedure. An endoleak can maintain a high systemic blood pressure within the aneurysm sac, potentially leading to rupture. Follow-up is therefore mandatory to detect and classify possible endoleaks. Computed tomography (CT) remains the gold standard for follow-up, but provides no hemodynamic information on endoleaks and has the disadvantages of exposing patients to iodine contrast and X-ray radiation. Exposure to radiation could be reduced in various ways, by simplifying the triphasic protocol using dual-energy CT imaging, limiting the amount of radiation per slice using iterative reconstruction, and reducing the follow-up schedule that could be altered to include non-ionizing radiation imaging techniques. Contrast-enhanced ultrasound (CEUS) is an interesting alternative to CT, as is magnetic resonance (MR) imaging that can be used as an alternative or for complementary imaging. Long-term follow-up schedules are currently based on repeated CT. However, more recently alternative follow-up protocols have been proposed for patients with no endoleaks nor increase in aneurysmal sac size. These new protocols consist of CT imaging at 1month and 1year after treatment, subsequently followed by CEUS. Nevertheless, the mechanical structure of the stent-graft must still be verified by CT. The use of patient-specific risk-adjusted follow-up protocols, based on preoperative imaging and the first postoperative results, is gradually becoming more and more widespread.

[Imaging of abdominal aortic aneurysms: when, how and why?]. / Quand, comment et pourquoi réaliser une imagerie d'un anévrisme de l'aorte abdominale?

Usually atherosclerotic in origin, aneurysms of the abdominal aorta (AAA) tend to involve the infrarenal aorta. Their biphasic exponential growth pattern, initially slow then accelerated, results in a risk of rupture. Surgical management is recommended for aneurysm diameters of 45-50mm or for growth rates more than 5mm in 6 Months. Imaging is useful for detection and follow-up of nonsurgical aneurysms, presurgical evaluation of aneurysms, and postsurgical follow-up. Frequently asymptomatic, AAA frequently is an incidental finding at the time of abdominal US. The size of the aneurysm sac, the presence of a neck and the size of the iliac arteries are assessed at the time of initial US detection. US is sufficient for follow-up of small aneurysms. Cross sectional imaging evaluation is necessary when surgery is contemplated. Readily available, multidetector row CT scanners with advanced image post-processing capabilities provide all the necessary information prior to surgical or endovascular management: evaluation of the aneurysm sac and neck, iliac and visceral arteries, and adjacent organs. Angiography with graduated catheters remains sometimes indicated. MR angiography provides results similar to CT but is less readily available and is usually reserved for patients with contraindication to iodinated contrast material. While follow-up imaging after surgical management is seldom performed, it is mandatory after endovascular management and includes KUB, Doppler US and CT or MR angiography.

Treatment of atheromatous renal artery in-stent restenosis in 51 patients.

OBJECTIVE: To evaluate our treatment of renal artery in-stent restenosis. PATIENTS AND METHODS: Monocentric retrospective study of 53 cases of restenosis and two occlusions in 51 patients detected via systematic follow-up with imaging (72.5%) and/or deterioration of kidney function (5.9%) and/or blood pressure failure (54.9%), 15.7 months (5-121) after implantation, giving rise to 49 recalibrations via a balloon and five additional stentings. Analysis of the technical results, the effects on blood pressure and kidney function after repeated revascularizations. RESULTS: Secondary permeability of 38 arteries (63.2%) after 12.4 months (3-64) with 14 second restenoses; 33.3% after redilation with a balloon, 60% after renewed stenting, more common in smokers (P=0.02), in case of peripheral arterial disease (P=0.02), ostial location (P=0.049) and kidney function impairment at the time of diagnosis of the restenosis (P=0.012). After 12.7 months (3-64) post-revascularization, kidney function was improved in 30% of patients and stabilised in 50% of patients. Treatment of second restenoses: one failure (7.1%), nine dilations with a balloon, three cutting balloon, one second stent. Treatment of third restenoses: 71.4% treated with a balloon (2), cutting balloon (2) or coated stent (DES) (1); then permeability at a later point in time: 50%. CONCLUSION: The treatment of repeated restenoses with conventional techniques is of imperfect efficacy, and currently remains un-codified.

Hypersplenism due to portal hypertension: retrospective evaluation of 17 patients treated by splenic embolization.

PURPOSE: The objective of this retrospective study was to analyze the efficacy and morbidity associated with splenic artery embolization for hypersplenism due to portal hypertension (PHT), as a function of the volume of the splenic parenchyma embolized and the type of PHT (due to intrahepatic block or segmental PHT). PATIENTS AND METHODS: This study retrospectively included 17 patients with hypersplenism secondary to PHT (intrahepatic block, n=14; segmental, n=3) treated by splenic artery embolization. The splenic volume embolized was estimated by computed tomography (CT) one month after embolization. A clinical assessment and platelet count took place at 7 days, 1 month and 6 months after the embolization. RESULTS: In the group with PHT due to intrahepatic block, the mean volume of embolized splenic parenchyma was 63% of the initial volume (range: 30-95%). Six months later, the platelet level had increased by an average of 232%. All patients with fewer than 80,000 platelets/mL at 6 months had an embolization volume less than 50%. In the segmental PHT group, the mean volume of the embolized parenchyma was 62% of the initial volume (range: 20-95%), bleeding symptoms had disappeared in all patients, and the platelet level exceeded 80,000/mL. Six patients (6/17, 35%) had complications, two minor and four major: two splenic abscesses, one respiratory distress with ascites, and one pancreatitis with ascites. Five of the six complications were observed in patients with a volume of embolized splenic parenchyma more than 70%. CONCLUSION: Our results show that splenic embolization of more than 50% of the parenchyma is effective in the treatment of hypersplenism due to PHT, but that when the embolized volume exceeds 70%, the procedure is associated with considerable morbidity.