title: Selective vascular isolation of the liver as part of initial damage control for grade 5 liver injuries: Shouldn't we use it more frequently?
abstract: BACKGROUND
  Severe liver trauma (grade 4 and 5) carries mortality greater than 40%. It represents a major surgical challenge in patients with hemodynamic instability who require an immediate exploratory laparotomy. Perihepatic packing and damage control can sometimes work, but for severe liver injuries, adjunct maneuvers might be needed (such as early embolization or hepatic artery ligation). During a patient's first operation for severe liver trauma, anatomic resection is rarely tolerated.
  
  
  METHODS
  We managed a 31 year-old male with a blunt grade 5 right-lobe liver injury in severe hypovolemic shock.
  
  
  RESULTS
  As part of the initial damage control operation, concurrently with intermittent Pringle maneuver, he underwent intra- and perihepatic packing; selective isolation and ligation of the right portal vein, right hepatic artery, and right hepatic vein; and repair of the retrohepatic inferior vena cava. Then, 36h later, the patient underwent a right hepatectomy.
  
  
  CONCLUSIONS
  For patients with severe liver injuries, selective vascular isolation and ligation may be considered as part of damage control (in addition to intermittent Pringle maneuver) and might enable anatomic resection at a later stage.
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ, USA; Trauma Section, Hamad Medical Corporation, Doha, Qatar. Electronic address: Latifi@surgery.arizona.edu.
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.affiliation: Hamad Medical Corporation, Transplant Section, Doha, Qatar.
authors.forename: Hatem
authors.initials: H
authors.lastname: Khalaf
keywords: Damage control; Embolization; Selective vascular isolation for liver injury; Severe liver injury