Metal Presence After Splenic Embolization
Yes, metallic embolic material (typically coils) will be present in the left upper quadrant after splenic artery embolization and will remain permanently visible on imaging studies.
Embolic Materials Used
The most common embolic agents used in splenic artery embolization are metallic coils, which create permanent metal artifacts in the left upper quadrant 1. These materials include:
- Metallic coils are the preferred embolic agent for splenic embolization, demonstrating lower rates of recurrent bleeding (12%) compared to other agents (36%) 1
- Amplatzer vascular plugs (8-12 mm diameter) can be used for precise proximal splenic artery embolization, deployed through 5-F or 6-F guiding catheters 2
- Cyanoacrylate (glue) may be used alone or in combination with coils, though coils remain the primary agent 1
Imaging Characteristics and Artifacts
The metallic embolic material creates specific imaging findings that persist indefinitely:
- CT imaging shows minimal artifact from devices like the Amplatzer vascular plug, with no evidence of migration or recanalization on follow-up studies 2
- Metal artifacts limit the usefulness of contrast enhancement for evaluating reperfusion after embolization, as the embolic material creates significant imaging artifacts 1
- Coil migration can occur as a minor complication in approximately 4.5% of cases, though the coils remain within the vascular system 1
Clinical Implications
The presence of metal has important practical considerations:
- The metal is permanent and intentional - coils depend on an intact coagulation cascade for thrombus formation between the metallic struts to ensure hemostasis 1
- Post-embolization imaging is affected - artifacts from embolic material limit contrast-enhanced evaluation, though strategies using dual-energy and spectral CT acquisition show promise for reducing metal artifacts 1
- No removal is necessary or indicated - the embolic material remains in place as part of successful treatment, with follow-up CT showing stable positioning without migration 2
Location Specificity
The exact location of metal depends on the embolization technique:
- Proximal embolization places coils in the main splenic artery distal to the dorsal pancreatic artery and proximal to the pancreatica magna branch 2
- Distal embolization places coils more peripherally in splenic artery branches, though this approach is associated with more major complications (24% vs 6% for proximal alone) 3
- Combined embolization may place metal in multiple locations throughout the splenic arterial tree 1