title: Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complications.
abstract: BACKGROUND
  The objective was to clarify the role of hepatic arterial embolization (AE) in the management of blunt hepatic trauma.
  
  
  METHODS
  Retrospective observational study of 183 patients with blunt hepatic trauma admitted to a trauma referral center over a 9-year period. The charts of 29 patients (16%) who underwent hepatic angiography were reviewed for demographics, injury specific data, management strategy, angiographic indication, efficacy and complications of embolization, and outcome.
  
  
  RESULTS
  AE was performed in 23 (79%) of the patients requiring angiography. Thirteen patients managed conservatively underwent emergency embolization after preliminary computed tomography scan. Six had postoperative embolization after damage control laparotomy and four had delayed embolization. Arterial bleeding was controlled in all the cases. Sixteen patients (70%) had one or more liver-related complications; temporary biliary leak (n=11), intra-abdominal hypertension (n=14), inflammatory peritonitis (n=3), hepatic necrosis (n=3), gallbladder infarction (n=2), and compressive subcapsular hematoma (n=1). Unrecognized hepatic necrosis could have contributed to the late posttraumatic death of one patient.
  
  
  CONCLUSIONS
  AE is a key element in modern management of high-grade liver injuries. Two principal indications exist in the acute postinjury phase: primary hemostatic control in hemodynamically stable or stabilized patients with radiologic computed tomography evidence of active arterial bleeding and adjunctive hemostatic control in patients with uncontrolled suspected arterial bleeding despite emergency laparotomy. Successful management of injuries of grade III upward often entails a combined angiographic and surgical approach. Awareness of the ischemic complications due to angioembolization is important.
authors: Department of Digestive and Emergency Surgery, Universitary Hospital and University Joseph Fourier, Grenoble, France. cletoublon@chu-grenoble.fr
authors: Christian
authors: C
authors: Letoublon
authors: Irene
authors: I
authors: Morra
authors: Yao
authors: Y
authors: Chen
authors: Valerie
authors: V
authors: Monnin
authors: David
authors: D
authors: Voirin
authors: Catherine
authors: C
authors: Arvieux