Proximal Splenic Artery Embolization (PSAE) for the Treatment of Refractory Ascites in Decompensated Cirrhosis

The purpose of this study is to learn whether a procedure called Proximal Splenic Artery Embolization (PSAE) can lower the need for repeat fluid drainage in adults with cirrhosis and a buildup of fluid in the abdomen (ascites) that is no longer controlled by water pills and diet. Participants in this study have already been told that a standard procedure called Trans jugular Intrahepatic Portosystemic Shunt (TIPS) is not a safe option for them. The main objectives this study aims to answer are:

• Does PSAE lower how often participants need paracentesis, the procedure used to drain fluid from the abdomen?
• Does PSAE lower the total amount of fluid drained each month?
• Does PSAE change the pressure inside the liver's veins and the blood flow in the liver and spleen?
• Does PSAE improve day-to-day symptoms, quality of life, strength, and the ability to do usual activities?
• What side effects or complications happen with PSAE in this group of people?

Participants will:

• Undergo one PSAE procedure, during which small coils and/or plugs are placed in the artery that supplies the spleen to slow its blood flow
• Have a pressure measurement taken in the liver's veins right before and right after the procedure, with a repeat measurement at 1 month
• Attend follow-up visits at 1, 3, and 6 months that include blood tests, ultrasounds, symptoms and quality-of-life questionnaires, and a review of any paracentesis sessions since the last visit
• Have a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) and an ultrasound of the liver and spleen blood vessels at the start of the study and again at 6 months