Outcomes and complications of angioembolization for hepatic trauma

Abstract

Background The liver is one of the most frequently injured abdominal organs. Hepatic hemorrhage is a complex and challenging complication following hepatic trauma. Significant shifts in the treatment of hepatic hemorrhage, including the increasing use of angioembolization, are believed to have improved patient outcomes. We aimed to describe the efficacy of angioembolization in the setting of acute hepatic arterial hemorrhage, as well as the complications associated with this treatment modality. Methods A systematic review of published literature (MEDLINE, SCOPUS, and Cochrane Library) describing hepatic angioembolization in the setting of trauma was performed. Articles that fulfilled the predetermined inclusion and exclusion criteria were included. We analyzed the efficacy rate of angioembolization in the setting of traumatic hepatic hemorrhage as well as the complications associated with hepatic angioembolization. Results Four hundred and fifty nine articles were identified in the literature search. Of these, 10 retrospective studies and 1 prospective study met inclusion and exclusion criteria. Efficacy rate of angioembolization was 93%. The most frequently reported complications following hepatic angioembolization included hepatic necrosis (15%), abscess formation (7.5%), and bile leaks. Conclusion Although the outcomes of hepatic angioembolization were generally favorable with a high success rate, the treatment modality is not without associated morbidity. The most frequently associated major complication was hepatic necrosis. Rates of complications were affected by study heterogeneity and should be better defined in future studies.

Transcatheter Arterial Embolization is an Efficient and Safe for Paediatric Blunt Torso Trauma: A Case Control Study

“…With regard to efficacy in this study, the rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% for all paediatric patients, which was similar to that for adult patients (88%). The success rate of TAE was also similar to the results of previous studies that reported 75-100% as the success rate of TAE in paediatric cohorts [8,20,21] and 77-100% in cohorts with both paediatric and adult patients [5,6]. Although we cannot compare the mortality rate directly between the paediatric and adult patients because there are differences in the injury site and severity between two groups, we found that the SMR of paediatric patients was lower than that of adults in this study.…”

“…There were no complications in paediatric patients, when we used the same diagnostic and therapeutic algorithm for blunt torso trauma patients with haemorrhage for all ages at our centre, which the complication rate in this study is similar to that reported in previous studies as mentioned 0-7% [4][5][6][7][8]. With regard to additional urgent therapy before and after the TAE, there were no significant differences in the proportion of patients who underwent urgent blood transfusion, resuscitative endovascular balloon occlusion of the aorta (REBOA), or surgical intervention in this study between paediatric and adult patients.…”

“…Due to advances in endovascular techniques for trauma patients, the therapeutic strategy in blunt torso trauma with haemorrhage changed from operative to non-operative management in the mid-1990s [4,5]. In adult patients, non-operative management has been established as a standard of care for trauma patients who are haemodynamically stable [3,4,6]. Previous studies reported transcatheter arterial embolization (TAE) as one of the non-operative management strategies to improve morbidity and mortality for blunt torso trauma patients with acute bleeding [3,5,6].…”

A modern, multicenter evaluation of hepatic angioembolization – Complications and readmissions persist

“…The largest systematic review for hepatic AE by Green et al found 15% developed hepatic necrosis across the series with a range of 0e43%. 9 Dabbs et al in contrast reported a significantly higher rate of hepatic necrosis, with 42% developing necrosis in seventy-one patients who underwent hepatic AE. We 27,28 The lower rate of hepatic necrosis likely represents improvements in catheter technology with the development of microcatheters allowing for improved arterial selectivity.…”

“…11e13 These studies reported efficacy for hepatic AE ranging from 81 to 100%, while the systematic review by Green et al reported a 77e100% success rate. 9 However, hepatic AE has been associated with a high rate of complications including hepatic necrosis, gallbladder infarction, bile leaks, and perihepatic abscesses. The most recent report by Kong et al reported a 27% liver related complication rate in hepatic AE-treated patients since 2009.…”