Hepatic Arterial Embolization in the Management of Blunt Hepatic Trauma: Indications and Complications

Létoublon, Christian; Morra, Irene; Chen, Yao; Monnin, V.; Voirin, David; Arvieux, C.

doi:10.1097/ta.0b013e31820e7ca1

Cited by 114 publications

(73 citation statements)

References 23 publications

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“…In the report with the largest number of the cases [5], 30 of 71 (42.3%) patients who had a high-grade liver injury developed hepatic infarction after TAE; 2 of those 30 died of hepatic infarction. In other reports, 1 of 14 (7.1%) patients [4], 3 of 23 (13.0%) patients [7], 3 of 23 (13.0%) patients [8], and 7 of 31 (22.6%) patients [9] developed hepatic infarction. There was one fatality in each of these reports.…”

Section: Discussionmentioning

confidence: 69%

“…after TAE for trauma [4,5,[7][8][9]. In the report with the largest number of the cases [5], 30 of 71 (42.3%) patients who had a high-grade liver injury developed hepatic infarction after TAE; 2 of those 30 died of hepatic infarction.…”

Section: Discussionmentioning

confidence: 98%

“…Five of these 6 underwent embolization of the LHA or RHA or their branches and none of the patients who were selectively treated in this way died, however, the other patient, who underwent nonselective embolization of the proper hepatic artery (PHA) using gelatin sponge particles, died. Letoublon et al [7] report that 3 of 23 patients developed hepatic necrosis after TAE. One among three patients underwent TAE in the superior posterior branch of the RHA, the other one in the posterior branch of the RHA, and the remaining one patient in the main trunk of RHA.…”

Section: Discussionmentioning

confidence: 99%

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Fatal Hepatic Necrosis after Transcatheter Arterial Embolization for Blunt Hepatic Trauma

Toguchi¹,

Tajima²,

Hagiwara³

et al. 2015

JCR

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Abstract:Hepatic necrosis after transcatheter arterial embolization (TAE) is rare because of the dual blood supply to the hepatic parenchyma via the portal vein and hepatic artery. We describe a patient with blunt hepatic injury who had a portal-systemic venous shunt in the right posterior segment of the liver and who suffered a fatal hepatic necrosis after TAE. A 74-year-old female with blunt hepatic injury was treated by TAE: both the right hepatic artery and middle hepatic artery were embolized using gelatin sponge particles. She developed multiple organ failure and died four days after the TAE. Autopsy revealed massive necrosis in the right lobe and left medial segment of the liver. To the best of our knowledge, this is the first report of hepatic necrosis after TAE for blunt liver trauma related to a portal-systemic venous shunt.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fatal Hepatic Necrosis after Transcatheter Arterial Embolization for Blunt Hepatic Trauma

Toguchi¹,

Tajima²,

Hagiwara³

et al. 2015

JCR

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“…Letoublon et al described a 70% morbidity rate in 23 patients treated with TAE [25]. According to the author, however, complications are not exclusively caused by the procedure itself, but also a consequence of complexity of liver trauma.…”

Section: Transarterial Angiographic Embolization (Tae)mentioning

confidence: 99%

Liver Trauma

Massani¹,

Bonariol²,

Pauletti³

et al. 2016

Actual Problems of Emergency Abdominal Surgery

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Objective: The aim of this section is to assess the evolution in the management of liver injuries during the last two decades. Methods:The authors reviewed the English literature, reporting the wider experiences, and on the basis of the personal experience, they suggest an up to date treatment.Results: Mortality due to hepatic injury has decreased over the past century from nearly 70% at the beginning of last century to the current level of 6-7%. This could be partially attributed to the improvement of operative techniques, to a lower surgical trend, to the application of damage control laparotomy in very complex liver trauma, and particularly to the diffusion of hepatic angiographic embolization. Scientific evidence has shown that more than 67% of laparotomies performed for blunt liver trauma are not therapeutic and in about 86% of all post-traumatic hepatic lesions the hemorrhage stopped spontaneously at the time of the laparotomy. On the other hand, blunt hepatic trauma can be conservatively treated in 70-90% of hemodynamic stable patients, in the absence of other associated lesions/peritoneal signs or in the case of limited need for transfusions. Thus far, the main decision criteria for a surgical rather than a conservative approach to the management of liver trauma have been the hemodynamic stability and not the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) grading of the lesion. Conclusions:Restricting the indications for a conservative treatment of liver traumas solely to the relief of hemodynamic stability seems nowadays to be unreasonable. Criteria for a conservative treatment are as follows: hemodynamic stability, limited need of blood transfusions, and non-associated visceral lesions on CT scan. In the presence of these conditions non-operative approach

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“…67 HAE is also used in selective embolisation of deep hepatic parenchymal bleeding in haemodynamically unstable patients with a grade 3 and above liver injury after a damage control laparotomy. 68,69 Liver-related complications of HAE (bile leaks, abscesses, and liver and gallbladder necrosis) run high (50-70%) 67,69 but selective HAE may reduce the latter. 70 HAE use has increased in trauma and it has been suggested that surgery may become an adjunct to HAE in level 1 trauma centres in those patients with borderline haemodynamic instability.…”

Section: Hepatic Injuriesmentioning

confidence: 99%

Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

Sharrock

Midwinter

2013

annals

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INTRODUCTION Trauma provision in the UK is a topic of interest. Regional trauma networks and centres are evolving and research is blossoming, but what bearing does all this have on the care that is delivered to the individual patient? This article aims to provide an overview of key research concepts in the field of trauma care, to guide the clinician in decision making in the management of major trauma. METHODS The Ovid MEDLINE ®, EMBASE™ and PubMed databases were used to search for relevant articles on haemorrhage control, damage control resuscitation and its exceptions, massive transfusion protocols, prevention and correction of coagulopathy, acidosis and hypothermia, and damage-control surgery. FINDINGS A wealth of research is available and a broad range has been reviewed to summarise significant developments in trauma care. Research has been categorised into disciplines and it is hoped that by considering each, a tailored management plan for the individual trauma patient will evolve, potentially improving patient outcome.

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Hepatic Arterial Embolization in the Management of Blunt Hepatic Trauma: Indications and Complications

Cited by 114 publications

References 23 publications

Fatal Hepatic Necrosis after Transcatheter Arterial Embolization for Blunt Hepatic Trauma

Fatal Hepatic Necrosis after Transcatheter Arterial Embolization for Blunt Hepatic Trauma

Liver Trauma

Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

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