Portal hypertension complicated with hypersplenism often leads to severe complications, while traditional splenectomy has its own limitations. From a surgical perspective, this article systematically explores the theoretical basis, precise practice strategies, and synergistic applications of partial splenic artery embolization (PSE) with other treatment modalities in managing this condition. PSE reduces splenic blood flow by embolizing distal splenic artery branches, thereby effectively lowering portal pressure, correcting cytopenia, alleviating the splenic steal phenomenon, improving hepatic perfusion, and preserving certain immune function. Precise implementation includes preoperative CT angiography and three-dimensional volumetric assessment to guide decision-making, intraoperative selective or non-selective embolization strategies, multimodal material combinations to optimize outcomes, and postoperative targeted management to prevent complications such as post-embolization syndrome, splenic abscess, and portal vein thrombosis. PSE can be integrated with splenectomy, transjugular intrahepatic portosystemic shunt (TIPS), transcatheter arterial chemoembolization (TACE), and liver transplantation as preoperative conditioning, bridging therapy, or a combined approach. In conclusion, PSE is a safe, minimally invasive, and effective treatment modality that has become a core component of multimodal therapy for portal hypertension with hypersplenism. In the future, advancements in novel materials, artificial intelligence, and precise imaging technologies will further enhance its efficacy, and surgeons should actively participate in multidisciplinary collaboration to develop individualized strategies for optimizing long-term patient prognosis.