Splenic arterial steal syndrome:a neglected therapeutic target for liver diseases

The liver is extremely susceptible to ischemia resulting from arterial hypoperfusion, which is confirmed by the graft arterial complications (such as hepatic artery thrombosis, aneurysm) after liver transplantation.Arterial hypoperfusion may lead to severe complications, e.g.ischemic biliary destruction, graft loss, even recipient death.Splenic arterial steal syndrome (SASS) is a seldom-recognized arterial complication following liver transplantation.SASS describes the phenomenon of poor arterial perfusion of hepatic parenchyma due to "stealing" or diverting of blood from the hepatic artery to the dilated splenic artery.SASS also can cause severe graft morbidity if it is not managed timely.However, there still has no clear concept of SASS in cirrhosis, moreover, the clinicians have not realized its risks to liver dysfunction.Cirrhotic SASS is a consequence of chronic liver disease, and conversely aggravates the liver damage.The clinical manifestation of cirrhotic SASS is not special, and mostly accompanied with abnormalities of poor liver function caused by underlying liver diseases and splenomegaly.We have confirmed the prevalence of SASS in patients with decompensated cirrhosis by 3-dimensional CT angiography and celiac angiography, and also have demonstrated that the liver function, Child-Pugh score and classification of cirrhotic patients can be improved after correction of SASS, as well as reducing the risks of gastrointestinal bleeding.In conclusion, this article firstly proposed the concept of cirrhotic SASS, and confirmed that SASS is an efficacious therapeutic target for improvement of liver function in patients with decompensated cirrhosis, which can be a bridging therapy for patients awaiting liver transplantation.