Angiographic embolization in the treatment of intrahepatic arterial bleeding in patients with blunt abdominal trauma

Kong, Yalin; Zhang, Hongyi; He, Xianli; Zhao, Gang; Liu, Chengli; Xiao, Mei; Zhen, Yuying

doi:10.1016/s1499-3872(14)60027-8

Cited by 28 publications

(30 citation statements)

References 17 publications

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“…The median ISS score for the study populations was 24 (range 16.9–36.9). Six studies did not record ISS scores 15, 17, 19–21, 23 . A total of 347 patients with hepatic hemorrhage were embolized from 1992 to 2012, accounting for 34.8% of the total study patients.…”

Section: Resultsmentioning

confidence: 99%

Outcomes and complications of angioembolization for hepatic trauma

Green

Bulger

Kwan

2016

Journal of Trauma and Acute Care Surgery

101

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Background The liver is one of the most frequently injured abdominal organs. Hepatic hemorrhage is a complex and challenging complication following hepatic trauma. Significant shifts in the treatment of hepatic hemorrhage, including the increasing use of angioembolization, are believed to have improved patient outcomes. We aimed to describe the efficacy of angioembolization in the setting of acute hepatic arterial hemorrhage, as well as the complications associated with this treatment modality. Methods A systematic review of published literature (MEDLINE, SCOPUS, and Cochrane Library) describing hepatic angioembolization in the setting of trauma was performed. Articles that fulfilled the predetermined inclusion and exclusion criteria were included. We analyzed the efficacy rate of angioembolization in the setting of traumatic hepatic hemorrhage as well as the complications associated with hepatic angioembolization. Results Four hundred and fifty nine articles were identified in the literature search. Of these, 10 retrospective studies and 1 prospective study met inclusion and exclusion criteria. Efficacy rate of angioembolization was 93%. The most frequently reported complications following hepatic angioembolization included hepatic necrosis (15%), abscess formation (7.5%), and bile leaks. Conclusion Although the outcomes of hepatic angioembolization were generally favorable with a high success rate, the treatment modality is not without associated morbidity. The most frequently associated major complication was hepatic necrosis. Rates of complications were affected by study heterogeneity and should be better defined in future studies.

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Section: Resultsmentioning

confidence: 99%

Outcomes and complications of angioembolization for hepatic trauma

Green

Bulger

Kwan

2016

Journal of Trauma and Acute Care Surgery

101

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“…Arguments in favor of observation are that solid organ PSAs have been shown to thrombose spontaneously [14] [15] and using AE to thrombose them is associated with multiple complications [16], while arguments in favor of treating them are that PSAs are associated with potential lethal complications [17,18]. Although there were three patients in this study with PSA on admission CT only one of them had PSA on angiography and they all survived.…”

Section: Discussionmentioning

confidence: 90%

Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

Younan

Beasley

Papoy

et al. 2017

International Surgery

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Abstract:Objective: Identify factors that would predict which patients would benefit from repeat imaging after major blunt liver injury. Summary of Background Data: Most patients who present with hemodynamic stability and no evidence of peritonitis after blunt liver injury are successfully managed nonoperatively. Little information is available regarding the utility of reimaging major blunt liver injuries for patients who are managed nonoperatively. Methods: A retrospective review of patients admitted to a level I trauma center with major blunt liver injuries (AAST grades 3-5) was conducted. Inclusion criteria were those admitted from July 2012 to June 2014 with blunt liver trauma who survived the first 24 hours and underwent repeat imaging. Data included demographics, procedures performed and computerized tomography (CT) scan findings. Findings on the second CT scan were categorized as Unchanged, Worse, Improved, or Negative. Results: 128 patients had blunt major liver injuries; 66 patients underwent repeat imaging. The mean time to repeat CT was 1.95 days. On repeat CT 47 were "Unchanged", 3 "Worse", 14 "Improved" and 2 "Negative". Three patients underwent angiography. One required embolization of a pseudoaneurysm. In 63 patients (95%), the second CT did not change the management plan. The presence of a pseudoaneurysm was significantly related to a worsening of the second CT (p=0.0475). Patients with admission hematocrit (Hct) below 32% were more likely to have a worsened second CT (p=0.0370). Conclusions: A pseudoaneurysm on admission CT and Hct <32% predict major liver injury progression suggesting that routine reimaging is warranted in this group.

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“…Além de evitar a morbidade da laparotomia imediata, o tratamento conservador de lesões hepáticas diminui a necessidade de transfusões sanguí-neas, o tempo de permanência hospitalar, inclusive na unidade de terapia intensiva (2,8) . Com a evolução dos métodos de radiologia intervencionista, a embolização seletiva mostrou-se mais eficiente comparada à capacidade de identificação e contenção do sangramento por procedimento aberto (7) , principalmente para lesões arteriais profundas do parênquima, em que a contensão cirúrgica por empacotamento é pouco eficaz (9) . Estima-se que em até 52% dos pacientes com lesão graus IV e V submetidos à laparotomia imediata, a evolução da doença progride com sangramento comprovado na arteriografia pós-operatória, sendo indicada embolização (9) .…”

Section: Discussionunclassified

“…Com a evolução dos métodos de radiologia intervencionista, a embolização seletiva mostrou-se mais eficiente comparada à capacidade de identificação e contenção do sangramento por procedimento aberto (7) , principalmente para lesões arteriais profundas do parênquima, em que a contensão cirúrgica por empacotamento é pouco eficaz (9) . Estima-se que em até 52% dos pacientes com lesão graus IV e V submetidos à laparotomia imediata, a evolução da doença progride com sangramento comprovado na arteriografia pós-operatória, sendo indicada embolização (9) . Além da opção terapêutica, a arteriografia se mostra uma ferramenta de valor inestimável para diagnóstico de complicações relacionadas ao trauma, tais como pseudoaneurismas, fistulas arteriovenosas intra-hepáticas, e hemobilia (7) .…”

Section: Discussionunclassified

Procedimento Endovascular Como Tratamento Não Cirúrgico Em Trauma Hepático Grau V: Um Relato De Caso

Coimbra

Sampaio

Silva

et al. 2016

ACS

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Conflito de interesses: Não AbstractIntroduction: Liver injuries occur in 16% of all poly-trauma patients. The American Association of Surgery of Trauma uses computer tomography findings to classify them into grades I through VI. Grade I, II and III lesions have better prognosis, and may be successfully treated with conservative clinical approaches. Grade IV through VI typically require surgical intervention. The present article presents the efficacy of endovascular treatment of Grade V liver injury in the medium and long terms, describing the clinical stabilization in acute phases and maintenance of hepatic function during a 6-month follow-up. Case Report: A 26-year-old male victim of blunt abdominal trauma and grade V liver injury had a successful hemodynamical stabilization after being subjected to arteriographic selective embolization. A surgical approach was necessary later on to remove intraabdominal clots, with adequate post-surgical evolution. The patient kept under follow up at the outpatient clinic for six months after the traumatic event, with full recovery of liver function and enzymes. Conclusion: Non-surgical treatment of grade V hepatic lesion may be used in selected cases in centers with hemodynamic and intensive care units.

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Angiographic embolization in the treatment of intrahepatic arterial bleeding in patients with blunt abdominal trauma

Cited by 28 publications

References 17 publications

Outcomes and complications of angioembolization for hepatic trauma

Outcomes and complications of angioembolization for hepatic trauma

Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

Procedimento Endovascular Como Tratamento Não Cirúrgico Em Trauma Hepático Grau V: Um Relato De Caso

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