title: Hepatic vascular injury: clinical profile, endovascular management and outcomes.
abstract: BACKGROUND
  Endovascular management using angiographic embolization (AE) has been widely used with success as non operative management (NOM) in blunt hepatic trauma. We, in a tertiary care hospital in North of India, assess our use of endovascular management in patients of blunt and post operative trauma with active hepatic vascular bleeding and unstable hemodynamics in controlling bleeding.
  
  
  METHODS
  A retrospective review of inpatients from January 2006 to July 2012 requiring transarterial embolization/stenting for active hepatic vascular bleeding was done. All patients had evidence of ongoing hemorrhage as proved by clinical, laboratory and radiological findings in emergency settings. Angiographic intervention in an interventional suite with ongoing resuscitation was performed following which patients were monitored for morbidity and mortality benefits on intermediate follow up.
  
  
  RESULTS
  10 adults and 3 children underwent AE with polyvinyl alcohol particle (PVA)/soft metal coil whereas 1 adult underwent revascularization with a covered stent for arterial bleeding. The mean age of case series was 36.18 ± 20.90 years with a mean liver injury computed tomography (CT) grade of 3.8 ± 0.83 in blunt trauma patients. The mean length of hospital stay was 9.62 ± 7.83 days and the mean follow up period of the group was 25.25 ± 21.02 months. All patients showed significant clinical improvement with prompt endovascular management resulting in no procedure related mortality.
  
  
  CONCLUSIONS
  Prompt endovascular management is the modality of choice in comparison to NOM without AE in both pediatric and adult patients with hemodynamically compromised inaccessible intra hepatic vascular trauma.
authors: Department of Cardiology, Dayanand Medical College, Ludhiana, Punjab, India. bishav_68@yahoo.co.in
authors: Bishav
authors: B
authors: Mohan
authors: Harpreet Singh
authors: HS
authors: Bhoday
authors: Naved
authors: N
authors: Aslam
authors: Harpreet
authors: H
authors: Kaur
authors: Shibba
authors: S
authors: Chhabra
authors: Naresh
authors: N
authors: Sood
authors: Gurpreet
authors: G
authors: Wander
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007194:India; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011142:Polyvinyl Alcohol; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D011142:Polyvinyl Alcohol