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

Abstract

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.

Factors associated with prolonged procedure time of embolization for trauma patients

“…To the best of our knowledge, this is the first report to assess the association between number of embolized arteries, number of embolized regions, and procedure time. A previous report from Japan showed the time to angiography did not differ by hemodynamic instability 22 . Our findings showed that procedure time was not statistically significantly associated with hemodynamic instability, disturbance of consciousness, or coagulopathy.…”

“…A previous report from Japan showed the time to angiography did not differ by hemodynamic instability. 22 Our findings showed that procedure time was not statistically significantly associated with hemodynamic instability, disturbance of consciousness, or coagulopathy. Regarding pelvic fracture, nonselective embolization had a tendency for a shorter procedure time (P = 0.056).…”

An observation-first strategy for liver injuries with “blush” on computed tomography is safe and effective

“…Avoiding empiric embolization in these patients (e.g., those without extravasation on angiography) would further limit morbidity, but our study suggests that this would insufficiently reduce the morbidity as compared with an initial trial of OBS. In addition, prior studies have noted a measurable failure rate of AE ranging from 7 to 33% 20–22 . While current guidelines from EAST and WTA support the use of hepatic AE in a stable liver-injured patient when blush is present on imaging, 1,2 our data suggest that an OBS-first strategy may be reasonable in lieu of embolization in select patients.…”

Management of severe liver injuries: push, pack, pringle – and plug!

“…The injury severity of the population is indicated by high injury severity scores (mean of 26), the overall mortality (6%) and that only one-third were hemodynamically stable. Despite the widespread differences between groups and the variation in the data they present [13], the authors conclude that angioembolization in hemodynamically unstable patients who had some respond to initial infusion therapy has acceptable in-hospital mortality and clinical failure rates. Of note, the association is not causation, and no causality can be drawn from such a retrospective, observational cohort.…”

“…While the role of interventional radiology continues to expand in trauma care, there is still scarce data on patients presenting with signs of hemodynamic instability and the outcome of this intervention. Thus, the report [13] in this issue of the Journal is timely and of interest to the wider readership. In their study Tamura and colleagues presented an observational, retrospective study enrolled patients with severe blunt liver injury (e.g.…”