Background The primary concern of trans-splenic access
for portal interventions is the risk of life-threatening
intraperitoneal bleeding.
Objective To review the clinical indications and efficacy
and evaluate the risk factors for intraperitoneal bleeding
during trans-splenic portal interventions in children.
Materials and Methods A retrospective review of consec-
utive patients who underwent trans-splenic portal interven-
tions at a tertiary care pediatric institution between March
2011 and April 2017 was performed. Forty-four procedures
were performed in 30 children with a median age of 5
(0.3–18) years. Clinical indications, technical success, pro-
cedural success, and incidence of complications were
recorded. Potential risk factors for intraperitoneal bleeding
were evaluated using Wilcoxon rank and Fisher’s exact tests.
Results Trans-splenic access was 100% successful. In 35/44
(79%) procedures, the subsequent intervention was successful
including recanalization of post-transplant portal vein occlu-
sion in 10/13, embolization of bleeding Roux limb varices in
8/8, recanalization of chronic portal vein thrombosis in native
liver in 7/13, splenoportography and manometry in 6/6, and

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• Trans-splenic Access for Portal Venous Interventions in Children: Do Benefits Outweigh Risks?