Influence of postoperative hepatic angiography on mortality after laparotomy in Grade IV/V hepatic injuries

Matsumoto, Shokei; Cantrell, Emily; Jung, Kyoungwon; Smith, Alan; Coimbra, Raúl

doi:10.1097/ta.0000000000001906

Cited by 12 publications

(10 citation statements)

References 27 publications

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“…Two principal indications for post-operative angiography-embolization (AG-AE) have been proposed: (1) after initial operative hemostasis, in stable or stabilized patients with contrast blush at completion CT scan; and (2) as adjunctive hemostatic tool in patients with uncontrolled suspected arterial bleeding despite emergency laparotomy and hemostasis attempt [34,54,[95][96][97][98][99]. Recent evidence suggests that routine use of immediate post-damage control hepatic angiography reduces mortality in grade IV/V hepatic injuries [100].…”

Section: Operative Managementmentioning

confidence: 99%

Liver trauma: WSES 2020 guidelines

et al. 2020

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Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

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Section: Operative Managementmentioning

confidence: 99%

Liver trauma: WSES 2020 guidelines

et al. 2020

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“…Liver resection should be avoided at this phase, but if absolutely necessary, non-anatomic resections should be preferred [2,47,48,52], while resection of a hemorrhaging spleen or kidney can be performed, if needed in order to stop the bleeding [29]. Angioembolization should be advocated for either stable patients after the initial surgical hemostatic attempt or adjunctively in case of suspected uncontrolled bleeding despite the surgical hemostatic attempt [2,47,55]; data also suggest that its routine implementation immediately after DCS can significantly improve survival in grade IV or V liver injury [56]. Regarding contamination control, intrahepatic abscesses can be managed with percutaneous drainage, and bilomas may either resolve spontaneously or should also be managed with percutaneous drainage potentially with adjunct therapeutic endoscopic retrograde cholangiopancreatography and stent placement [47].…”

Section: Damage Control Phase I (Dci)mentioning

confidence: 99%

Damage Control Surgery for Liver Trauma

Ziogas¹,

Katsaros²,

Tsoulfas³

2021

Trauma and Emergency Surgery - The Role of Damage Control Surgery

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The liver is one of the most commonly injured organs of the abdomen after major trauma and may lead to the extravasation of major amounts of blood. Damage control surgery (DCS) as a concept exists for over one hundred years but has been more widely optimized and implemented over the past few decades. Minimizing the time from the trauma scene to the hospital and recognizing the patterns of injury and the "lethal triad" (acidosis, hypothermia, coagulopathy) is vital to understand which patients will benefit the most from DCS. Immediate patient resuscitation, massive blood transfusion, and taking the patient to the operating room as soon as possible are the critical initial steps that have been associated with improved outcomes. Bleeding and contamination control should be the priority in this first exploratory laparotomy, while the patient should be transferred to the intensive care unit postoperatively with only temporary abdominal wall closure. Once the patient is stabilized, a second operation should be performed where an anatomic liver resection or other more major procedures may take place, along with permanent closure of the abdominal wall.

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“…24 There are decreased mortality rates by treating with angiography in addition to open laparotomy. 27 Most previously studied cases have used physically separate angiography suites from operating rooms, and patients are triaged to either the operating room or the angiography suite. In one study, 63% of unstable patients underwent hepatic embolization as a first intervention.…”

Section: B Hemodynamically Unstable Adult Patientmentioning

confidence: 99%

Contemporary Management of Hepatic Trauma: What IRs Need to Know

Gilyard

Shinn

Nezami

et al. 2020

Semin intervent Radiol

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Trauma remains one of the leading causes of death in the United States in patients younger than 45 years. Blunt trauma is most commonly a result of high-speed motor vehicular collisions or high-level fall. The liver and spleen are the most commonly injured organs, with the liver being the most commonly injured organ in adults and the spleen being the most affected in pediatric blunt trauma. Liver injuries incur a high level of morbidity and mortality mostly secondary to hemorrhage. Over the past 20 years, angiographic intervention has become a mainstay of treatment of hepatic trauma. As there is an increasing need for the interventional radiologists to embolize active hemorrhage in the setting of blunt and penetrating hepatic trauma, this article aims to review the current level of evidence and contemporary management of hepatic trauma from the perspective of interventional radiologists. Embolization techniques and associated outcome and complications are also reviewed.

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Influence of postoperative hepatic angiography on mortality after laparotomy in Grade IV/V hepatic injuries

Abstract: Therapeutic study, level IV.

Cited by 12 publications

References 27 publications

Liver trauma: WSES 2020 guidelines

Liver trauma: WSES 2020 guidelines

Damage Control Surgery for Liver Trauma

Contemporary Management of Hepatic Trauma: What IRs Need to Know

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