title: Ischemic liver injuries after hepatic artery embolization in patients with delayed postoperative hemorrhage following hepatobiliary pancreatic surgery.
abstract: BACKGROUND
  Many collateral pathways to the liver are dissected during hepatobiliary pancreatic surgery and, if the arterial bleeding is massive and a hematoma becomes larger, the adjacent portal vein can be compressed with impairment of the portal venous flow.
  
  
  OBJECTIVE
  To evaluate the frequency and severity of ischemic liver injuries after hepatic artery embolization in patients with delayed postoperative arterial hemorrhage after hepatobiliary pancreatic surgery.
  
  
  METHODS
  Eighteen patients undergoing proper or common hepatic artery embolization for delayed postoperative arterial hemorrhage after hepatobiliary pancreatic surgery achieved hemostasis. To evaluate the frequency and severity of ischemic liver injuries, the liver enzyme levels and CT findings before and after hepatic artery embolization were retrospectively compared and the clinical outcomes after hepatic artery embolization were analyzed. Angiographic findings were also analyzed to reveal any association with development of ischemic liver injuries after hepatic artery embolization.
  
  
  RESULTS
  Ischemic liver injuries were observed in 15 (83%) of 18 patients undergoing hepatic artery embolization for postoperative hemorrhage. Injuries included hepatic infarction combined with abscess in one (5%) patient, hepatic infarction in 12 (67%) patients, and transient hepatic ischemia/dysfunction in two (11%). As for the extent of hepatic infarction, lobar infarction developed in two patients and subsegmental infarction in 11. One patient with right hepatic lobar infarction died of hepatic failure 11 days after hepatic artery embolization. In the other 14 patients with ischemic liver injuries, the elevated liver enzymes returned to baseline levels within two weeks. All of the four patients with portal vein stenosis, four patients with no hepatic arterial flow on post-embolization angiogram, and one patient with both had hepatic infarction after hepatic artery embolization. No ischemic liver injuries developed after hepatic artery embolization in three patients with no portal vein stenosis and bilobar hepatic arterial flow via the left hepatic artery aberrantly arising from the left gastric artery or from the common hepatic artery.
  
  
  CONCLUSIONS
  Ischemic liver injuries can develop in most patients undergoing hepatic artery embolization for postoperative arterial hemorrhage after hepatobiliary pancreatic surgery; hepatic infarction appears to be the most frequent type of ischemic liver injury. Hepatic artery embolization for postoperative arterial hemorrhage after hepatobiliary pancreatic surgery may carry a great risk of ischemic liver injury if a patient has portal vein stenosis or no aberrant hepatic artery.
authors.affiliation: Department of Radiology, Kangwon National University College of Medicine, Kangwon-do, Korea. chosk@skku.edu
authors.forename: Sung Ki
authors.initials: SK
authors.lastname: Cho
authors.forename: Sam Soo
authors.initials: SS
authors.lastname: Kim
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Do
authors.forename: Kwang Bo
authors.initials: KB
authors.lastname: Park
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Shin
authors.forename: Hong Suk
authors.initials: HS
authors.lastname: Park
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Choo
authors.forename: In Wook
authors.initials: IW
authors.lastname: Choo
mesh_terms: D000038:Abscess / Q000209:etiology; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic; D013505:Digestive System Surgical Procedures; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities; D006801:Humans; D007238:Infarction / Q000209:etiology; D007511:Ischemia / Q000209:etiology*; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000473:pathology; D019106:Postoperative Hemorrhage / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed