309 - Hepatic Angioembolization for Unstable and Coagulopathic Trauma

Purpose: Hepatic angioembolization (HAE) in hemodynamically (HD) unstable trauma remains controversial. This study is the first to utilize updated 2018 AAST-OIS classification {1} to guide HAE as a primary intervention in high acuity trauma.

Materials and Methods: We retrospectively examined 213 patients initially managed with hepatic angiography at a Level 1 trauma center from 1/1/2015 to 8/1/2025. Patients managed with damage control laparotomy were excluded. HD unstable defined as persistent hypotension < 90 mmHg or ATLS Grade 3-4 hemorrhagic shock. Coagulopathy was defined as INR > 1.4 or hypothermia < 35 C. Primary endpoints include complications (bleeding, bile leak, necrosis), re-intervention, and mortality. Hypothesis testing performed using Student’s t-test and Chi-Squared test.

Results: The study population presented with severe hepatic (mean AAST 3.7) and polytraumatic (mean ISS 34) injury. Clinically, 55% were unstable and 38% were coagulopathic. The majority would be indicated for surgical intervention.



Hemodynamic (HD) instability was strongly associated with degree of hepatic injury (AAST Grade 3.5 vs. 3.8, p=0.004), polytrauma (ISS 39.1 vs. 26.5, p< 0.001), and coagulopathy (53% vs. 20%, p< 0.001). Similarly, coagulopathy correlated with hepatic injury (AAST Grade 3.8 vs. 3.6, p=0.04), polytrauma (ISS 38.1 vs. 30.6, p< 0.001), and HD instability (77% vs. 42%, p< 0.001).



Clinical success was achieved in 87% of unstable and 83% of coagulopathic patients with HAE. These outcomes are within the reported range of HAE success in stable patients {2} and superior to laparotomy {3}.



HAE in unstable patients was associated with higher total complications (23% vs. 8%, p=0.004) and re-interventions for bleeding (13% vs. 4%, p=0.03). Coagulopathy also led to higher total complications (28% vs. 9%, p=0.001) and re-intervention for bleeding (17% vs. 4%, p< 0.001). Current literature on HAE in stable hepatic trauma report a comparable 29% complication rate {4}. Laparotomy has reported morbidity rates of 28% for unstable hepatic trauma {5}.



Overall reported mortality after from traumatic hepatic causes is far lower with HAE than laparotomy (5.6% vs. 23%) {2, 5}. There were no cases of hepatic-related mortality in this study.

Conclusion: HAE is safe and effective in unstable and coagulopathic trauma patients. Clinical success of 83-87% comparable with reported outcomes for stable patients (77-100%). Morbidity and mortality are lower than standard surgical approach to unstable hepatic trauma.