Selective hepatic arterial embolization of grade IV and V blunt hepatic injuries: an extension of resuscitation in the nonoperative management of traumatic hepatic injuries.
BACKGROUND
Recognizing the significant mortality and complications inherent in the operative management of blunt hepatic injuries, hepatic arterial embolization was evaluated as a bridge between operative and nonoperative interventions in patients defined as hemodynamically stable only with continuous resuscitation.


METHODS
Seven of 11 patients with grade IV or V hepatic injuries identified by computed tomography underwent hepatic arterial embolization. A prospective evaluation of hepatic embolization based on subsequent hemodynamic parameters was assessed by matched-pair analysis. A summary of this study population's demographic data and outcomes is presented, including age, Glasgow Coma Scale score, Injury Severity Score, Revised Trauma Score, computed tomography grade, intensive care unit and hospital length of stay, transfusion requirements, complications, and mortality.


RESULTS
No statistical difference was demonstrated between pre-embolization and postembolization hemodynamics and volume requirements. After embolization, however, continuous resuscitation was successfully reduced to maintenance fluids. Hepatic embolization was the definitive therapy for all seven patients who underwent embolization.


CONCLUSIONS
Results of this preliminary investigation suggest that hepatic arterial embolization is a viable alternative bridging the therapeutic options of operative and nonoperative intervention for a subpopulation of patients with hepatic injury.
Department of Trauma/EMS, Hartford Hospital, Connecticut, USA.
D L
DL
Ciraulo
S
S
Luk
M
M
Palter
V
V
Cowell
J
J
Welch
V
V
Cortes
R
R
Orlando
T
T
Banever
L
L
Jacobs
D000328:Adult; D000465:Algorithms; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003663:Decision Trees; D004621:Embolization, Therapeutic / Q000379:methods*; D005440:Fluid Therapy / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000293:injuries*; D016555:Matched-Pair Analysis; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*