Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review |
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Authors: | F. Virdis I. Reccia S. Di Saverio G. Tugnoli S.H. Kwan J. Kumar J. Atzeni M. Podda |
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Affiliation: | 1. General Surgery Department, Hillingdon Hospital NHS Foundation Trust, Uxbridge, UB8 3NN, London, United Kingdom;2. Haepato-Biliary-Pancreatic Unit, Hammersmith Hospital, Imperial College, Du Cane Road W120HS, London, United Kingdom;3. Department of Surgery, Addenbrooke''s Hospital, Hills Rd, CB2 0QQ, Cambridge, United Kingdom;4. Trauma and Emergency Surgery Unit, Maggiore Hospital, Largo Nigrisoli, 2, 40133 Bologna BO, Italy;5. Royal Perth Hospital, 97, Wellington St, Perth WA 6000, Australia;6. Department of Surgery & Cancer, Imperial College, Du Cane Road, W120HS London, United Kingdom;7. General and Emergency Surgery Unit, Ns Signora di Bonaria Hospital, 09037 San Gavino, Italy;8. General, Emergency and Robotic Surgery Unit, San Francesco Hospital, 08100 Nuoro NU, Italy |
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Abstract: | PurposeThis purpose of this systematic review was to determine the safety and efficacy of arterial embolization as the primary treatment for grade III-V liver trauma, excluding the postoperative use of arterial embolization.Material and methodsA total of 24 studies published between January 2000 and June 2018 qualified for inclusion in this study. Four of them were prospective studies and 20 were retrospective. A total of 3855 patients (mean age, 33.5 years; range: 22–52.5 years) were treated non-operatively and 659 patients (659/3855; 17.09%) with hepatic hemorrhage underwent primary arterial embolization from 2000 to 2017. Indication for arterial embolization was a contrast blush visible on computed tomography in hemodynamically stable patient in all studies.ResultsThe arterial embolization success rate ranged from 80% to 97%. The most commonly reported complication was bile leak, with an incidence of 5.7%. Nineteen bilomas (2.8%) were reported in five studies with a range between 4% and 45%. Hepatic ischemia was reported in eight studies, with a mean incidence of 8.6%.ConclusionPrimary arterial embolization has a high success rate in patients with hepatic trauma. Complications, including biloma and hepatic ischemia, have acceptable rates in the context of a minimally-invasive procedure that allows stabilization of life-threatening, complex liver injuries. |
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Keywords: | Angioembolization Liver trauma Non operative management Interventional radiology CT: computed tomography NOM: non-operative management AAST: American Association for the Surgery of Trauma ISS: high injury severity score |
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