title: The need for early angiographic embolization in blunt liver injuries.
abstract: BACKGROUND
  Although nonoperative management of blunt liver injury (BLI) has become standard practice, adjuncts to nonoperative therapy, such as angiographic embolization, have not been well characterized.
  
  
  METHODS
  Patients with BLI were retrospectively identified at our American College of Surgeons-verified Level I trauma center from January 1997 through February 2001. Patients were stratified into four groups: those who received angiographic embolization (AE) as an early intervention when BLI was initially diagnosed (EARLY-AE); those who underwent AE after liver-related operation or later in the hospital course (LATE-AE); those treated with operation only (OR-ONLY); and nonoperative patients who also did not undergo AE (NO-OR).
  
  
  RESULTS
  There were 126 patients with BLI, of whom 94 were NO-OR, 20 were OR-ONLY, 6 had LATE-AE, and 6 had EARLY-AE. The NO-OR group had significantly lower liver Abbreviated Injury Scale scores. Liver Abbreviated Injury Scale scores were not different between the EARLY-AE, LATE-AE, and OR-ONLY groups. Liver-related mortality was not lower for those treated with AE. There was a trend toward lower mortality for just the EARLY-AE group compared with the LATE-AE and OR-ONLY groups (0% vs. 50% and 35%). The number of units of packed red blood cells transfused and the number of liver-related operations were lower in the EARLY-AE compared with the LATE-AE group, but liver-related complications were not different between the EARLY-AE, LATE-AE, or OR-ONLY groups. AE was successful in arresting hemorrhage in 83% of the cases.
  
  
  CONCLUSIONS
  In this small series, we observed similar morbidity and mortality with AE compared with operative therapy. EARLY-AE did decrease blood use and the number of liver-related operations. AE can be performed on severely injured patients with comparable liver-related mortality and complications. Further study of the timing of and outcomes from AE is needed.
authors.affiliation: Division of Trauma Burn and Emergency Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0033, USA. wlwahl@med.umich.edu
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Wahl
authors.forename: Karla S
authors.initials: KS
authors.lastname: Ahrns
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Brandt
authors.forename: Glen A
authors.initials: GA
authors.lastname: Franklin
authors.forename: Paul A
authors.initials: PA
authors.lastname: Taheri
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000601:surgery / Q000628:therapy*