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

Abstract

The liver is the most frequently injured organ during abdominal trauma. Vascular injuries account for approximately 3% to 25% of all cases of liver trauma and are typically treated by transarterial embolization (TAE). We describe a case of American Association for the Surgery of Trauma grade V liver injury with a very large pseudoaneurysm and an arteriohepatic venous fistula (AHVF), which failed to respond to TAE. This case was successfully treated using a direct transhepatic glue injection without complications. AHVF is an exceedingly rare type of vascular injury in blunt trauma. Direct transhepatic glue injections could represent a reliable alternative to TAE for the treatment of visceral pseudoaneurysms, especially if TAE fails to eliminate the lesion.