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SIR 2026

Traditional Poster

Embolization

Session: Traditional Poster Presentations

529 - Angioembolization Improves Survival After Damage Control Laparotomy and Resuscitative Thoracotomy for Hepatic Trauma

Monday, April 13, 2026
12:10 PM - 1:10 PM ET
Purpose: Hepatic angioembolization (HAE) is one of the only interventions associated with decreased mortality after damage control laparotomy (DCL) for hepatic trauma. This study is the largest to date, which examines outcomes of HAE after DCL and resuscitative thoracotomy (RT).

Materials and Methods: We retrospectively examined 96 patients who underwent DCL at a Level 1 trauma center from 1/1/2015 to 8/1/2025. Nine also required resuscitative thoracotomy for lost pulses. 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) and mortality.

Results: DCL patients presented with severe trauma (mean AAST 4.2, ISS 40) {1}. The majority were unstable (86%) and coagulopathic (84%). Hepatic-related mortality was 1% (overall 19.5%). Morbidity rate was 32%, comprising bleeding (11%), bile leak (14%), abscess (7%), and necrosis (7%).


DCL + RT patients were all unstable and coagulopathic (100%), with Grade V hepatic injury (100%) and extensive polytrauma (mean ISS 55). Survival rate was 22%. Overall mortality was 77%, with 11% from hepatic causes. Morbidity was 33% overall, and 100% for surviving patients.



Operative hepatic trauma is associated with 51-65% mortality {2-4}. With HAE mortality drops to 20-30% in small sub-group analysis {2} and database studies {5}. This study shows 19.5% mortality with DCL, reaffirming previous reports of survival benefit.

Post-thoracotomy outcomes of hepatic trauma have a reported 100% mortality {2}. If the patient survives to receive HAE, mortality decreases to 77% in this study.

Mortality benefits in this study occurred despite more severe injury (mean ISS 40-55 vs. 33-37) than previous studies on DCL {2-4}.

Conclusion: This study demonstrates increased survival with HAE after damage control laparotomy (DCL) and resuscitative thoracotomy (RT). Previously, this was only suggested by small sub-group analysis and database query studies.