Hepatic Pseudoaneurysm Incidence after Liver Trauma

Delayed splenic pseudoaneurysm identification with surveillance imaging

“…Following an initial retrospective study of solid organ pseudoaneurysm development, an institutional protocol was changed to plan for dedicated repeat CT-angiograms for all grades IV and V solid organ injuries as well as grade III solid organ injuries with concern for contrast blush or pseudoaneurysm on admission CT. 11 A retrospective review of all traumatically injured patients who sustained blunt injury to the spleen was evaluated at a single level 1 trauma academic institution from 2018 to 2020. All patients who sustained splenic injury were further subdivided into four groups based upon the extent of splenic injury using the American Association for the Surgery of Trauma splenic injury scoring system: grades I and II, grade III, grade IV, and grade V. 12 The outcomes of interest included emergent versus delayed (>6 hours) splenectomy, splenorrhaphy, emergent or delayed (>6 hours) interventional radiology (IR) procedure, follow-up CT imaging, presence/absence of splenic pseudoaneurysm, and outcomes after identification of pseudoaneurysm.…”

Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist

“…2 Presentation ranges from clinically asymptomatic 26 to expanding hematomas and delayed bleeding. [1][2][3]27 Though cases of splenic artery pseudoaneurysm (PSA) are known to thrombose and self-resolve, hepatic PSAs are less well described and are associated with high rates of rupture, and are therefore treated with arterial embolization. 1,26,27 It is unclear whether ultrasound is effective for the assessment of PSA, and therefore CT angiography (CTA) is preferred.…”

“…The appropriateness of CTA screening for all patients with hepatic trauma by day 5 is a matter of debate. 26,27 PSAs may be treated by coil embolization or stent exclusion, described in more depth in another section of this publication.…”

Transhepatic glue injection for hepatic pseudoaneurysm and arteriohepatic venous fistula after the failure of transarterial embolization

“…Liver injuries are the most frequent type of abdominal trauma, and more than 50% of cases are classified as American Association for the Surgery of Trauma (AAST) high-grade injuries (III, IV, and V). 1 High-grade hepatic injuries often include liver vascular injuries, such as pseudoaneurysm (PSA), arterial-venous fistula, and contrast extravasation due to damaged blood vessel walls, typically requiring interventional treatment. [2][3][4][5][6][7][8] Transarterial embolization (TAE) is the current standard treatment for vascular injuries, with a high success rate and low morbidity.…”