CPT® Code 38200

1. Indications

The injection procedure for splenoportography is indicated for various clinical scenarios where visualization of the splenic vasculature and its connection to the portal vein is necessary. The following conditions may warrant this procedure:

• Assessment of Splenic Vascular Anatomy This procedure is performed to evaluate the blood supply to the spleen and to identify any vascular anomalies or abnormalities.
• Investigation of Portal Hypertension Splenoportography can help in assessing the presence and extent of portal hypertension, which may be due to conditions such as cirrhosis or thrombosis of the portal vein.
• Evaluation of Splenic Disorders It is indicated in cases of splenic diseases, such as splenic tumors or splenomegaly, where detailed vascular imaging is required for diagnosis or treatment planning.

2. Procedure

The procedure for splenoportography involves several meticulously executed steps to ensure accurate imaging and patient safety. The following outlines the procedural steps:

• Step 1: Preparation The procedure begins with the cleansing of the abdominal skin to reduce the risk of infection. A local anesthetic is then injected into the area overlying the spleen to ensure patient comfort during the procedure.
• Step 2: Needle Insertion Under fluoroscopic guidance, a sheathed needle is carefully inserted into the spleen. The fluoroscopy provides real-time imaging, allowing the physician to navigate the needle accurately into the spleen.
• Step 3: Needle Position Verification Once the needle is positioned along the long axis of the spleen towards the splenic hilum, it is removed, and the correct position of the sheath is verified by checking for free blood return, indicating successful access to the splenic circulation.
• Step 4: Pressure Measurement The splenic pulp pressure is measured using a manometer, which provides important hemodynamic information about the spleen.
• Step 5: Contrast Injection A small amount of contrast material is injected to confirm proper sheath placement. Following this test injection, a larger volume of contrast media is injected into the spleen, which is essential for visualizing the splenic veins.
• Step 6: Imaging The contrast is observed as it drains from the splenic vasculature into the portal vein, and cineangiography is performed to capture the dynamic flow of the contrast through the vascular structures.
• Step 7: Radiographs Separate radiographs are obtained of the splenic vasculature and the portal vein to provide additional diagnostic information.
• Step 8: Tamponade and Dressing After the injection procedure is complete, compressed Gelfoam plugs are inserted through the sheath to tamponade the entire needle tract, minimizing the risk of bleeding. The sheath is then removed, and a dressing is applied to the site to protect it.

3. Post-Procedure

Post-procedure care following splenoportography involves monitoring the patient for any immediate complications, such as bleeding or infection at the injection site. Patients are typically advised to rest and may be observed for a short period to ensure stability. Instructions regarding activity restrictions and signs of potential complications, such as increased pain or swelling at the site, should be provided. Follow-up imaging or assessments may be scheduled based on the findings from the procedure and the clinical context.