Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review

Virdis, Francesco; Reccia, Isabella; Saverio, Salomone Di; Tugnoli, Gregorio; Kwan, Sherman; Jayant, Kumar; Atzeni, Jenny; Podda, Mauro

doi:10.1016/j.diii.2018.10.004

Cited by 44 publications

(37 citation statements)

References 55 publications

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“…The nonoperative management (NOM) through transcatheter arterial embolization (TAE) of blunt liver injury is reportedly associated with a success rate of 80-97% when used with advanced techniques in interventional radiology (IR). 1 In addition, guidelines recommend TAE as the rst-line therapy in hemodynamically stable patients with blunt liver injury. 2 However, there are recommendations (Level of Evidence I) for laparotomy in patients who are hemodynamically unstable, and NOM should not be selected for the management of patients with hemodynamic instability.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter arterial embolization of severe blunt liver injury in hemodynamically unstable patients: a retrospective 15-year study

Tamura¹,

Kashimi²,

Maruhashi³

et al. 2020

Preprint

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Background Non-operative management with Transcatheter arterial embolization(TAE) was the first line of treatment for severe blunt liver injury in hemodynamically stable patients, but in the case of hemodynamically unstable, Operative management(OM) was recommended. We evaluated the efficacy of TAE in our hospital where intervention radiology was available 24 hours a day if the patient responds to initial infusion therapy even unstable.Methods We conducted a retrospective study of severe blunt liver injury of AAST Organ Injury Scale(OIS) grade 3–5 transported to our hospital between 2005 and 2019. If the patient responded to initial infusion therapy, even though hemodynamically unstable(Shock Index ≧ 1), CT was taken and initial treatment was decided. We compared patients who underwent OM or TAE on initial treatment.Results 62 patients were included (8 OM, 54 TAE), with a mean ISS of 26.6, in hospital mortality of 6%(13% OM VS 6% TAE, p = 0.50), hemodynamically unstable of 35% (88% OM VS 28% TAE, p < 0.01) and Time from Door to start OM/TAE 81.8 min(120.0 OM VS 76.1 TAE, p = 0.02). Unstable patients who undergo TAE were associated with 7% in hospital mortality and 7% clnical failure. After logistic regression the choice of treatment was not a predictor of outcome, the predictor of in-hospital mortality death was GCS on arrival(OR0.48, P < 0.01), hemodynamically unstable was independent predictor of duration of ICU ≧ 7 days(OR 3.80, p = 0.05) and massive blood transfusion(OR 7.25, p = 0.01). the predictor of complication was OIS grade4-5(OR 6.61 p < 0.01).Conclusions The strategy of performing TAE even in the presence of hemodynamically unstable in a facility where TAE can be performed promptly was acceptable mortality and clinical failure. The choice of treatment did not affect the outcome, and hemodynamically unstable and OIS affected the prognosis.

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Section: Introductionmentioning

confidence: 99%

Transcatheter arterial embolization of severe blunt liver injury in hemodynamically unstable patients: a retrospective 15-year study

Tamura¹,

Kashimi²,

Maruhashi³

et al. 2020

Preprint

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“…Complications of blunt liver trauma such as hepatic necrosis, liver abscess and biloma have been reported previously [8][9][10][11][12][13] . Among them, the most concerning complication is hepatic necrosis.…”

Section: Discussionmentioning

confidence: 94%

“…According to a study by Dabb et al, patients with hepatic necrosis had higher grade of liver injuries and were more likely to have undergone damage control surgery in addition to embolization 8 . However, these complications may occur regardless of whether blunt liver trauma is treated with observational, embolization or surgery [8][9][10][11][12][13] . In this study, only two patients developed infected biloma and was successfully treated with percutaneous catheter drainage.…”

Section: Discussionmentioning

confidence: 99%

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Differences of liver CT perfusion of blunt trauma treated with therapeutic embolization and observation management

Wong

Wang

et al. 2020

Sci Rep

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Massive hepatic necrosis after therapeutic embolization has been reported. We employed a 320-detector CT scanner to compare liver perfusion differences between blunt liver trauma patients treated with embolization and observation. This prospective study with informed consent was approved by institution review board. From January 2013 to December 2016, we enrolled 16 major liver trauma patients (6 women, 10 men; mean age 34.9 ± 12.8 years) who fulfilled inclusion criteria. Liver CT perfusion parameters were calculated by a two-input maximum slope model. Of 16 patients, 9 received embolization and 7 received observation. Among 9 patients of embolization group, their arterial perfusion (78.1 ± 69.3 versus 163.1 ± 134.3 mL/min/100 mL, p = 0.011) and portal venous perfusion (74.4 ± 53.0 versus 160.9 ± 140.8 mL/min/100 mL, p = 0.008) were significantly lower at traumatic parenchyma than at non-traumatic parenchyma. Among 7 patients of observation group, only portal venous perfusion was significantly lower at traumatic parenchyma than non-traumatic parenchyma (132.1 ± 127.1 vs. 231.1 ± 174.4 mL/min/100 mL, p = 0.018). The perfusion index between groups did not differ. None had massive hepatic necrosis. They were not different in age, injury severity score and injury grades. Therefore, reduction of both arterial and portal venous perfusion can occur when therapeutic embolization was performed in preexisting major liver trauma, but hepatic perfusion index may not be compromised.

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“…Gelatin sponge, liquid embolics (such as glue or onyx), and metallic coils are commonly used materials for embolization. 8 Virdis et al reviewed 24 studies on arterial embolization and found a 6% rebleeding rate postembolization, 0.7% mortality, and 28% complication rate. 8 Complications of arterial embolization include biloma (2.8%), hepatic ischemia or necrosis (8.6%), liver abscess (6.8%), gallbladder necrosis (3.6%), abdominal compartment syndrome (2%), peritonitis (1.9%), and septic complications (0.6%).…”

Section: Angiographic Managementmentioning

confidence: 99%

Hepatic Trauma Interventions

Pillai

Kumar

Pillai

2021

Semin intervent Radiol

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The liver is the second most commonly involved solid organ (after spleen) to be injured in blunt abdominal trauma, but liver injury is the most common cause of death in such trauma. In patients with significant blunt abdominal injury, the liver is involved approximately 35 to 45% of the time. Its large size also makes it a vulnerable organ, commonly injured in penetrating trauma. Other than its position and size, the liver is surrounded by fragile parenchyma and its location under the diaphragm makes it vulnerable to shear forces during deceleration injuries. The liver is also a vascular organ made of large, thin-walled vessels with high blood flow. In severe hepatic trauma, hemorrhage is a common complication and uncontrolled bleeding is usually fatal. In fact, in patients with severe abdominal trauma, liver injury is the primary cause of death. This article reviews the clinical presentation of patients with liver injury, the grading system for such injuries that is most frequently used, and management of the patient with liver trauma.

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Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review

Cited by 44 publications

References 55 publications

Transcatheter arterial embolization of severe blunt liver injury in hemodynamically unstable patients: a retrospective 15-year study

Transcatheter arterial embolization of severe blunt liver injury in hemodynamically unstable patients: a retrospective 15-year study

Differences of liver CT perfusion of blunt trauma treated with therapeutic embolization and observation management

Hepatic Trauma Interventions

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