SIR 2024
Embolization
Eric C. Schoen, BA
Medical Student
University of Louisville
Financial relationships: Full list of relationships is listed on the CME information page.
Yaw Ohene-Baah, MD
Interventional Radiologist
University of Louisville Department of Radiology
Disclosure information not submitted.
Motor vehicle collisions (MVCs) are the most common source of blunt hepatic injuries in the general population {1}. Embolization is a minimally invasive endovascular technique commonly used for controlling bleeding in the setting of trauma. Despite its widespread use, there is a relative lack of assessment of proper patient selection and outcomes in hepatic artery embolization in patients with blunt hepatic injuries. This study aims to evaluate the characteristics of MVC patients who received hepatic artery embolizations to identify patients who would be ideal candidates for minimally invasive treatment of blunt hepatic injuries.
Materials and Methods:
This study compiled hepatic injury data at the University of Louisville Hospital for 2013-2022. We characterized hepatic injury at this level 1 trauma center based on AAST guidelines and grading standards. A retrospective chart review was utilized to determine patients who received hepatic embolization following motor vehicle collisions. Treatment failure was determined as the need for surgical control of the hepatic laceration.
Results:
A total of 854 patients with MVC-associated blunt hepatic injuries were identified over ten years. Twenty-one hepatic artery embolizations were performed in sixteen of these patients. Most embolized patients arrived hemodynamically unstable (11; 69%) and received blood products within the first four hours of their hospital stay. There were 2 (13%) patients with Grade II injuries, 11 (73%) with Grade IV, and 2 (13%) with Grade V injuries. The most commonly embolized artery was the right hepatic (13; 62%), followed by the left hepatic (7; 33%) and the proper hepatic artery (1; 5%). Recurrent hemorrhage occurred in two patients, both of which went on to receive hepatorrhaphy. Repeat embolization was required in one of these patients after hepatorrhaphy, which stabilized the bleed indefinitely. One additional patient required hepatorraphy due to retained hemoperitoneum. Of the three patients who received post-embolization hepatorrhaphy, 2 (67%) were Grade V hepatic injuries.
Conclusion:
Hepatic artery embolization is used relatively rarely in patients with blunt hepatic injuries following motor vehicle collisions. Our results demonstrate high success rates in patients with Grade IV or lower hepatic injuries, which may support the argument for increased utilization of this technique in this population. Embolization of Grade V hepatic injuries may be associated with higher rates of treatment failure and the need for subsequent surgery.