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Meram E, Russell E, Ozkan O, Kleedehn M. Variceal and Nonvariceal Upper Gastrointestinal Bleeding Refractory to Endoscopic Management: Indications and Role of Interventional Radiology. Gastrointest Endosc Clin N Am 2024; 34:275-299. [PMID: 38395484 DOI: 10.1016/j.giec.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
For over 60 years, diagnostic and interventional radiology have been heavily involved in the evaluation and treatment of patients presenting with gastrointestinal bleeding. For patients who present with upper GI bleeding and have a contraindication to endoscopy or have an unsuccessful attempt at endoscopy for identifying or controlling the bleeding, interventional radiology is often consulted for evaluation and consideration of catheter-based intervention.
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Affiliation(s)
- Ece Meram
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Elliott Russell
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Orhan Ozkan
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Mark Kleedehn
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA.
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2
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Metias M, Liu E, Troncone M, Alsulaimani M, Szalay D. Open surgical repair of giant hepatic artery aneurysm. J Vasc Surg Cases Innov Tech 2022; 8:825-829. [PMID: 36561357 PMCID: PMC9763355 DOI: 10.1016/j.jvscit.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Hepatic artery aneurysms (HAAs) are visceral artery aneurysms with a significant risk of mortality upon rupture. HAAs can be treated with open or endovascular repair. The choice of treatment modality depends on aneurysm anatomy, adequacy of visceral collaterals, and overall health status of the patient. This case report describes the successful repair of a giant 14.9-cm HAA through open aneurysm resection and end-to-end anastomosis of the distal common hepatic artery to the gastroduodenal artery. The patient recovered postoperatively with no complications and normal liver function. This case report also reviews other giant HAAs that have been reported in literature.
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Affiliation(s)
- Maged Metias
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Eva Liu
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael Troncone
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohammed Alsulaimani
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | - David Szalay
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada,Correspondence: David Szalay, MD, Division of Vascular Surgery, McMaster University, 5 North, Hamilton General Hospital, 237 Barton Street, East Hamilton, ON L8L 2X2, Canada
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Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
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Choudhary A, Barakat MT, Higgins LJ, Banerjee S. Choledochoscopic Identification of a Hepatic/Cystic Artery Pseudoaneurysm in a Patient with Hematemesis After Laparoscopic Cholecystectomy. Dig Dis Sci 2017; 62:1439-1442. [PMID: 27423886 DOI: 10.1007/s10620-016-4243-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Abhishek Choudhary
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Luke J Higgins
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA.
- , 300 Pasteur Drive Rm H0262, MC 5244, Palo Alto, CA, 94305, USA.
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Kahn SL, McClain J, Kaufman JL. Massive Hemorrhage From Multiple Hepatic Artery Aneurysms. Vasc Endovascular Surg 2016; 50:507-510. [PMID: 27630223 DOI: 10.1177/1538574416668116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 66-year-old man, with an abnormal porta hepatis, consistent with tumor or inflammation, developed massive bleeding from one of numerous hepatic artery aneurysms, and coil embolization achieved control of bleeding. He died of subsequent multisystem organ failure, and the most likely diagnosis was either polyarteritis nodosa or segmental arterial mediolysis. Although the dual hepatic blood supply allows a degree of arterial embolization, this case demonstrates the risks associated with large territory hepatic arterial embolization in the presence of hemodynamic instability. We discuss the management issues related to massive hepatic bleeding when no surgical approach is possible.
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Affiliation(s)
- S Lowell Kahn
- Department of Surgery, Baystate Vascular Services, Baystate Medical Center, Springfield, MA, USA
| | - Jonathan McClain
- Department of Surgery, Baystate Vascular Services, Baystate Medical Center, Springfield, MA, USA
| | - Jeffrey L Kaufman
- Department of Surgery, Baystate Vascular Services, Baystate Medical Center, Springfield, MA, USA
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Nayak HK, Saraswat VA, Mohindra S, Prasad R, Karyampudi A. Upper Gastrointestinal Bleed Following Percutaneous Liver Abscess Drainage. J Clin Exp Hepatol 2015; 5:349-51. [PMID: 26900278 PMCID: PMC4723642 DOI: 10.1016/j.jceh.2015.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/03/2015] [Indexed: 12/12/2022] Open
Affiliation(s)
- Hemanta K. Nayak
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Samir Mohindra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India,Address for correspondence: Samir Mohindra, Associate Professor, Department of Gastroenterology, C Block, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
| | - Raghunandan Prasad
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Arun Karyampudi
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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Hung JS, Chou ASB, Chen CL. An unusual case of hemobilia. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Zaleska-Dorobisz U, Lasecki M, Olchowy C, Ugorski W, Garcarek J, Patkowski D, Kurcz J. Iatrogenic hemobilia in 10-year-old boy. Pol J Radiol 2014; 79:279-82. [PMID: 25191530 PMCID: PMC4152250 DOI: 10.12659/pjr.890410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/17/2014] [Indexed: 11/23/2022] Open
Abstract
Background Hemobilia in children is a rare phenomenon which has been described mostly in the context of traumas. The descriptions of massive hemobilia in children after liver biopsy are a rarity in the scientific literature because there are only a few examples of it. Hemobilia rarely develops spontaneously. Generally, this is a complication after a blunt abdominal trauma or after medical (especially surgical) procedures. Correct diagnosis and treatment of hemobilia are essential, especially in the case of patients with severe – sometimes life-threatening – haemorrhage from biliary ducts. It should be remembered that the symptoms of hemobilia do not necessarily occur immediately after surgery or trauma. In some cases hemobilia occurs after a changeable, asymptomatic period of time. Case Report We would like to present a case of a severe form of hemobilia caused by arterio-biliary fistula which developed incidentally after liver biopsy in a 10-year-old boy with chronic hepatitis B. Symptoms of hemobilia appeared on the seventh day after the diagnostic biopsy when the patient’s general condition began to deteriorate. The diagnosis of arterio-biliary fistula was established after angio-CT examination of the liver. A selective embolization of the right hepatic artery was carried out. Hemobilia in children is a rare phenomenon which has been described mostly in the context of traumas. The cases of massive hemobilia in children after liver biopsy are a rarity in the scientific literature because there are only a few examples of it. Hemobilia very rarely develops spontaneously. Generally, this is a complication after a blunt abdominal trauma or after medical (especially surgical) procedures. Results Correct diagnosis and treatment of hemobilia are essential, especially in the case of patients with severe – sometimes life-threatening – haemorrhage from biliary ducts. It should be remembered that the symptoms of hemobilia do not necessarily occur immediately after surgery or trauma. In some cases hemobilia occurs after a changeable, asymptomatic period of time.
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Affiliation(s)
| | - Mateusz Lasecki
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
| | - Cyprian Olchowy
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
| | - Wojciech Ugorski
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
| | - Jerzy Garcarek
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery, Wrocław University of Medicine, Wrocław, Poland
| | - Jacek Kurcz
- Department of Radiology, Wrocław University of Medicine, Wrocław, Poland
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Fonio P, Cassinis MC, Rapellino A, Righi D, Gandini G. Interventional radiology in the treatment of early postoperative biliary complications. Radiol Med 2012; 118:386-400. [PMID: 22872455 DOI: 10.1007/s11547-012-0863-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 09/27/2011] [Indexed: 12/15/2022]
Abstract
PURPOSE We sought to evaluate the feasibility and efficacy of percutaneous treatment of early postoperative biliary complications. The primary aims were to evaluate clinical and technical success and complications and perioperative mortality, and secondary aims were to evaluate treatment duration and recurrence rate. MATERIALS AND METHODS Between March 2007 and March 2010, 75 patients (42 men and 33 women; age range, 17-88 years; mean age, 60.8 years) underwent interventional radiology procedures to treat early postoperative biliary complications of biliary and pancreatic-duodenal surgery with biliodigestive anastomosis (37.7%), laparoscopic cholecystectomy (30.6%), hepatic resection (21.1%) and several other surgical procedures (10.6%). Complications included fistulas (73%), stenoses (20%) and complete bile duct transections (7%). RESULTS Interventional radiology achieved complete clinical success in 74 cases (85.9%) and in particular in 95.2% of fistulas, 76.5% of stenoses and 33.3% of complete bile duct transections. Mean indwelling catheter time was 34.9 days, with an average of 4.1 procedures. There were two cases of severe haemobilia (2.3%). Minor complications occurred in 7% of cases. Perioperative mortality rate was 1.2% and overall recurrence rate 6.7% (range, 1-18 months; mean, 10 months), with recurrences occurring predominantly in stenoses. All patients were retreated successfully. CONCLUSIONS Percutaneous procedures are feasible, effective and safe for treating early postoperative biliary complications. They provide a valuable alternative to presendoscopy, which is precluded in many of these patients, and to surgery, which has higher morbidity and mortality rates.
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Affiliation(s)
- P Fonio
- Istituto di Radiologia, Università degli Studi di Torino, Ospedale S Giovanni Battista di Torino, Torino, Italy.
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10
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Transcatheter arterial embolization for iatrogenic hemobilia is a safe and effective procedure: case series and review of the literature. Eur J Gastroenterol Hepatol 2012; 24:905-9. [PMID: 22617365 DOI: 10.1097/meg.0b013e328354ae1b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Hemobilia is an uncommon cause of gastrointestinal bleeding. The etiology is diverse, but most often, it is iatrogenic. The present study aims to reassess the clinical picture and the treatment of choice. METHODS We describe a case series from a single center of patients who presented with nontraumatic iatrogenic hemobilia. RESULTS Over a period of 8 years, hemobilia occurred in 12 patients: following liver biopsy in six patients and after endoscopic biliary interventions in four patients, with a respective prevalence of 0.1 and 0.04%. The clinical presentation was characterized by an upper gastrointestinal bleeding (n=11) and/or biochemical signs of sudden biliary obstruction (n=9). The onset of the symptoms occurred after a median of 6 days (range: 1-23). Ultrasound and computed tomography scan missed the diagnosis in, respectively, 4/5 and 2/5 of patients. On arteriography, pseudoaneurysm (6/12) was the most common finding. Transcatheter arterial embolization controlled the bleeding in all cases (12/12) without major complications. CONCLUSION The delay between the intervention and the clinical presentation and the fact that imaging studies may fail to diagnose hemobilia may mislead the physician. Transcatheter arterial embolization is the treatment of choice for hemobilia. It has proven to be effective and safe and it offers a long-term definitive cure.
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11
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Vyas S, Ahuja CK, Yadav TD, Khandelwal N. Emergency ultrasound-guided percutaneous embolization of post-traumatic bleeding hepatic artery pseudoaneurysms. MINIM INVASIV THER 2011; 21:372-6. [PMID: 22142183 DOI: 10.3109/13645706.2011.642077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hepatic artery pseudoaneurysm (HAP) is an uncommon but serious complication of blunt trauma abdomen which can be managed by non-surgical interventional methods. We describe the case of a young boy with blunt trauma abdomen having a large hepatic laceration associated with two pseudoaneurysms of the hepatic artery branches. Both these HAPs were successfully managed by percutaneous injection of cyanoacrylate glue under sonographic guidance. A major surgery was thus averted. A brief review of the etiology, diagnosis and management of HAP including the present case is discussed.
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Affiliation(s)
- Sameer Vyas
- Departments of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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12
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Tokue H, Takeuchi Y, Sofue K, Arai Y, Tsushima Y. Ultrasound-guided thrombin injection for the treatment of an iatrogenic hepatic artery pseudoaneurysm: a case report. J Med Case Rep 2011; 5:518. [PMID: 22017919 PMCID: PMC3212963 DOI: 10.1186/1752-1947-5-518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/21/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Percutaneous transhepatic portal embolization is often performed to expand the indications for hepatic resection. Various etiologies of hepatic artery pseudoaneurysm have been reported, but regardless of the etiology, hepatic artery pseudoaneurysm is usually managed with an endovascular approach or open surgery, depending on the location and clinical symptomatology. However, it is difficult to manage hepatic artery pseudoaneurysm after percutaneous transhepatic portal embolization, since embolization of the hepatic artery may cause hepatic infarction CASE PRESENTATION A 58-year-old Japanese man with hilar bile duct cancer underwent percutaneous transhepatic portal embolization to expand the indication for hepatic resection. Two days after percutaneous transhepatic portal embolization, our patient suddenly complained of abdominal pain. Contrast-enhanced computed tomography confirmed a pseudoaneurysm arising from a segmental branch of his right hepatic artery. Since embolization of the hepatic arterial branches may cause hepatic infarction, ultrasound-guided thrombin injection therapy was successfully performed for the pseudoaneurysm. CONCLUSION We performed a thrombin injection instead of arterial embolization to avoid hepatic infarction. The rationale of this choice may be insufficient. However, ultrasound-guided percutaneous thrombin injection therapy may be considered as an alternative to percutaneous transarterial embolization or surgical intervention for an iatrogenic hepatic artery pseudoaneurysm.
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Affiliation(s)
- Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Maebashi, Gunma, Japan.
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Adkisson CD, Sibulesky L, Collis GN, McLaughlin DW, Oldenburg WA, Nguyen JH. Aneurysmectomy and revascularization of a large hepatic artery aneurysm. Ann Vasc Surg 2011; 25:556.e11-5. [PMID: 21549927 DOI: 10.1016/j.avsg.2010.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
Aneurysms of the hepatic artery are rare, but are associated with significant mortality because of their lack of symptoms at presentation and risk of rupture. We report a case of an enlarging 4-cm hepatic artery aneurysm involving the proximal common hepatic artery to the bifurcation of the right and left hepatic arteries which was found incidentally on ultrasound examination. Endovascular treatment with a stent was considered, but because of the location of the aneurysm as well as the presence of significant thrombosis involving the right and left hepatic arteries, aneurysmectomy and revascularization using saphenous vein was performed. Doppler ultrasound measurements demonstrated good flow through the graft postoperatively and at 1-month follow-up. Although a variety of endovascular techniques exist to treat hepatic artery aneurysms, our results indicate that open excision and revascularization may be required and can have a good outcome.
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Abstract
The nonoperative management including endovascular treatment of traumatic injuries to most abdominal solid viscera is increasingly gaining acceptance as treatment of choice in a select group of patients. The indications, techniques, and principles of endovascular management of hepatic, splenic, and renal injuries are discussed in this review.
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Affiliation(s)
- A Rao Chimpiri
- Department of radiology, Oklahoma University of Health Sciences, Oklahoma City, Oklahoma
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Mirsadraee S, Tirukonda P, Nicholson A, Everett SM, McPherson SJ. Embolization for non-variceal upper gastrointestinal tract haemorrhage: a systematic review. Clin Radiol 2011; 66:500-9. [PMID: 21371695 DOI: 10.1016/j.crad.2010.11.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 11/02/2010] [Indexed: 12/16/2022]
Abstract
AIM To assess the published evidence on the endovascular treatment of non-variceal upper gastrointestinal haemorrhage. MATERIALS AND METHODS An Ovid Medline search of published literature was performed (1966-2009). Non-English literature, experimental studies, variceal haemorrhage and case series with fewer than five patients were excluded. The search yielded 1888 abstracts. Thirty-five articles were selected for final analysis. RESULTS The total number of pooled patients was 927. The technical and clinical success of embolization ranged from 52-100% and 44-100%, respectively. The pooled mean technical/clinical success rate in primary upper gastrointestinal tract haemorrhage (PUGITH) only, trans-papillary haemorrhage (TPH) only, and mixed studies were 84%/67%, 93%/89%, and 93%/64%, respectively. Clinical outcome was adversely affected by multi-organ failure, shock, corticosteroids, transfusion, and coagulopathy. The anatomical source of haemorrhage and procedural variables did not affect the outcome. A successful embolization improved survival by 13.3 times. Retrospective comparison with surgery demonstrated equivalent mortality and clinical success, despite embolization being applied to a more elderly population with a higher prevalence of co-morbidities. CONCLUSIONS Embolization is effective in this very difficult cohort of patients with outcomes similar to surgery.
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Affiliation(s)
- S Mirsadraee
- Department of Radiology, Leeds General Infirmary, Leeds, UK
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Affiliation(s)
| | - Blair Henderson
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chris Preachuk
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Tokuda T, Tanigawa N, Shomura Y, Kariya S, Kojima H, Komemushi A, Shiraishi T, Sawada S. Transcatheter embolization for peripheral pseudoaneurysms with n-butyl cyanoacrylate. MINIM INVASIV THER 2010; 18:361-5. [PMID: 19929299 DOI: 10.3109/13645700903201100] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this study is to evaluate the clinical efficacy of transcatheter embolization for pseudoaneurysms of peripheral arteries with n-butyl cyanoacrylate (NBCA). From November 2000 to February 2008, 17 patients with 18 pseudoaneurysms were treated by transcatheter embolization at our affiliated hospitals. The locations of the pseudoaneurysms were right hepatic artery (n=3), renal artery (n=5), splenic artery (n=2), gastroduodenal artery (n=2), common hepatic artery (n=1), pancreatic arcade (n=1), external iliac artery (n=1), internal iliac artery (n=1), internal thoracic artery (n=1), and left gastric artery (n=1). We assessed technical success rate, embolization methods, and clinical course in this study. The technical success rate was 94.4% (17/18 cases). Embolization methods were isolation (n=17) and packing (n=1). Only NBCA was used in 14 cases, both coils and NBCA were used in four cases. Six patients were in shock prior to the procedure, but all patients recovered immediately after embolization procedure including transfusion. None of the patients died of procedure-related factors or had notable postoperative complications, but three patients died within a week of the procedure because of deterioration of the underlying disease. In conclusion, transcatheter embolization of pseudoaneurysms with NBCA is a safe and effective technique for treatment.
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Affiliation(s)
- Takanori Tokuda
- Department of Radiology, Kansai Medical University, Osaka, Japan.
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Pollono EN, Madoff DC, Spence SC, Suarez-Almazor ME. Multiple hepatic artery aneurysms in a patient with systemic lupus erythematosus. Lupus 2009; 19:93-5. [PMID: 19884215 DOI: 10.1177/0961203309345721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Systemic vasculitis is a known complication of patients with systemic lupus erythematosus (SLE). Inflammation of the vessels can result in the development of arterial aneurysms with a potential risk of rupture or bleeding. CASE HISTORY We present the case of a 56-year-old woman with SLE who developed three episodes of gastrointestinal (GI) bleeding without evidence of lesions in the GI tract. Multiple aneurysms of the hepatic artery were identified and treated with endovascular embolization, with no further GI bleeding. After embolization, the patient developed multiple bilomas that required percutaneous drainage, and subsequent abscesses which eventually resolved without further complications. CONCLUSION Hepatic aneurysms, possibly secondary to vasculitis, may cause GI bleeding, and should be suspected in patients with SLE and GI bleeding with no apparent cause identifiable through standard endoscopy of the upper and lower GI tract.
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Affiliation(s)
- E N Pollono
- Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, Section of Rheumatology, the University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Contrast-Enhanced Ultrasound-Guided Microwave Tissue Coagulation Therapy for Hepatic Trauma: An Experimental Study. ACTA ACUST UNITED AC 2008; 64:1079-84. [DOI: 10.1097/ta.0b013e318031ccdb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Asensio JA, Petrone P, García-Núñez L, Kimbrell B, Kuncir E. Multidisciplinary approach for the management of complex hepatic injuries AAST-OIS grades IV-V: a prospective study. Scand J Surg 2008; 96:214-20. [PMID: 17966747 DOI: 10.1177/145749690709600306] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Complex hepatic injuries grades IV-V are highly lethal. The objective of this study is to assess the multidisciplinary approach for their management and to evaluate if survival could be improved with this approach. STUDY DESIGN Prospective 54-month study of all patients sustaining hepatic injuries grades IV-V managed operatively at a Level I Trauma Center. MAIN OUTCOME MEASURE survival. STATISTICAL ANALYSIS univariate and stepwise logistic regression. RESULTS Seventy-five patients sustained penetrating (47/63%) and blunt (28/37%) injuries. Seven (9%) patients underwent emergency department thoracotomy with a mortality of 100%. Out of the 75 patients, 52 (69%) sustained grade IV, and 23 (31%) grade V. The estimated blood loss was 3,539+/-3,040 ml. The overall survival was 69%, adjusted survival excluding patients requiring emergency department thoracotomy was 76%. Survival stratified to injury grade: grade IV 42/52-81%, grade V 10/23-43%. Mortality grade IV versus V injuries (p < 0.002; RR 2.94; 95% CI 1.52-5.70). Risk factors for mortality: packed red blood cells transfused in operating room (p=0.024), estimated blood loss (p < 0.001), dysryhthmia (p < 0.0001), acidosis (p = 0.051), hypothermia (p = 0.04). The benefit of angiography and angioembolization indicated: 12% mortality (2/17) among those that received it versus a 36% mortality (21/58) among those that did not (p = 0.074; RR 0.32; 95% CI 0.08-1.25). Stepwise logistic regression identified as significant independent predictors of outcome: estimated blood loss (p= 0.0017; RR 1.24; 95% CI 1.08-1.41) and number of packed red blood cells transfused in the operating room (p = 0.0358; RR 1.16; 95% CI 1.01-1.34). CONCLUSIONS The multidisciplinary approach to the management of these severe grades of injuries appears to improve survival in these highly lethal injuries. A prospective multi-institutional study is needed to validate this approach.
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Affiliation(s)
- J A Asensio
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California Keck School of Medicine, LAC + USC Medical Center, Los Angeles, California, USA.
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Luebke T, Heckenkamp J, Gawenda M, Beckurts KTE, Lackner K, Brunkwall J. Combined Endovascular–Open Surgical Procedure in a Great Hepatic Artery Aneurysm. Ann Vasc Surg 2007; 21:807-12. [PMID: 17703916 DOI: 10.1016/j.avsg.2007.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 04/21/2007] [Accepted: 06/28/2007] [Indexed: 10/21/2022]
Abstract
Visceral artery aneurysms are rare lesions. They involve the hepatic artery in approximately 20% of cases. Various therapeutic options are available for patients with hepatic artery aneurysms (HAAs). Dictated predominately by the need to maintain distal end-organ perfusion, potential therapies include traditional surgical techniques and laparoscopic surgery, endovascular methods of embolization, and stenting of the lesions. There is still a lack of studies demonstrating the comparative efficacy or inefficacy of any particular treatment, so there are currently no precise indications for determining which type of treatment should be used. In this paper, we present a case of great HAA in a 59-year-old man. He was preoperatively diagnosed and treated with a combined surgical and endovascular approach. The clinical presentation, management, and therapy of patients with HAAs are discussed. In addition to that, we reviewed the literature dealing with HAAs. This case report lays emphasis on the aspect that the treatment strategy in HAAs has to be determined individually in each case due to the high anatomic variability of the arterial supply of the liver. Treatment with a combined surgical and endovascular approach may reduce the risk of liver ischemia and morbidity.
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Affiliation(s)
- T Luebke
- Division of Vascular Surgery, University of Cologne, Cologne, Germany.
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22
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Petroianu A. Arterial embolization for hemorrhage caused by hepatic arterial injury. Dig Dis Sci 2007; 52:2478-81. [PMID: 17410453 DOI: 10.1007/s10620-006-9704-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Accepted: 11/26/2006] [Indexed: 12/30/2022]
Abstract
Fewer than 10% of patients with major liver trauma have life-threatening bleeding. Laparoscopic operations, endoscopic procedures, and percutaneous interventions such as drainages, vascular or tumor sclerosis, biopsies, and transjugular intrahepatic portocaval shunt (TIPS) have increased the number of iatrogenic vascular and bile duct injuries. Due to its therapeutic success, arterial embolization (AE) has become the standard treatment for late complications of hepatic injury. In some cases, this procedure may be used as the first approach on accidental or iatrogenic arterial trauma and in several hepatic arterial diseases. The result of this method depends on physician experience, size of the wound, and stability of the patient. Persistent hemorrhage and rebleeding may be treated with a new AE or an operation. Precise indication and a correctly performed AE are key factors for a successful treatment. Rebleeding episodes are a rare occurrence, which may be treated with AE as well.
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Affiliation(s)
- A Petroianu
- Department of Surgery, Medical School, Federal University of Minas Gerais, AvenidaAlfredo Balena 190, Belo Horizonte, MG, 30130-100, Brazil.
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23
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Lynskey GE, Banovac F, Chang T. Vascular complications associated with percutaneous biliary drainage: a report of three cases. Semin Intervent Radiol 2007; 24:316-9. [PMID: 21326476 DOI: 10.1055/s-2007-985742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Percutaneous biliary drainage is a common interventional radiology procedure. It is usually performed in the setting of biliary obstruction, benign or malignant, after endoscopic approach failed or is technically not possible. Percutaneous biliary drainage has a relatively low complication rate, and most complications that occur are usually self-limited. Major complications, however, can occur. In this article, we report three major hemorrhagic complications and their management. They include hemorrhage secondary to fistula formation and pseudoaneurysm formation occurring several days to weeks subsequent to the initial drain placement.
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Affiliation(s)
- George E Lynskey
- Department of Radiology, Georgetown University School of Medicine, Washington, District of Columbia
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24
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Successful superselective embolization of posttraumatic pseudoaneurysm of replaced hepatic artery in a child with situs inversus totalis. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200708020-00019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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25
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Chevallier P, Novellas S, Vanbiervliet G, Staccini P, Le Conte L, Hébuterne X, Bruneton JN. [Transcatheter embolization for endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage]. ACTA ACUST UNITED AC 2007; 88:251-8. [PMID: 17372552 DOI: 10.1016/s0221-0363(07)89811-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Evaluate the efficacy of endovascular embolization for patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage as well as the factors that may influence mortality. MATERIALS AND METHODS. Retrospective study over a 4-year period including a historical cohort of 37 consecutive patients (22 men), with a mean age of 69.2 years (range, 22-93 years). In most cases (54%), the hemorrhage stemmed from a gastrointestinal ulcer. Technical, primary clinical, and secondary clinical success rates, as well as complication rates, were calculated. Several clinical and angiographic parameters were compared to the early mortality rate using Kruskal-Wallis or Fisher tests. RESULTS Technical, primary clinical, secondary clinical success rates, and complication rates were, respectively, 89.2%, 83.8%, 88.9%, and 10.8%. The early mortality rate was 32.4%. The APACHE II and IGS II scores were strongly correlated with mortality (p=0.001 and p=0.003, respectively). CONCLUSION Endovascular embolization in patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage is effective. However, the mortality rate remains high because of the changes in the clinical condition of these patients.
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Affiliation(s)
- P Chevallier
- Service de d'Imagerie diagnostique et interventionnelle, Hôpotal Archet II, Nice Cedex 03, France.
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26
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Bilbao Jaureguízar JI, Vivas Pérez I, Cano Rafart D, Martínez de la Cuesta A. Imaging and Intervention in Gastrointestinal Hemorrhage and Ischemia. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Goffette PP. Imaging and Intervention in Post-traumatic Complications (Delayed Intervention). Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Dwivedi AJ, Greben C, Krishnasastry KV. Catheter embolization of an hepatic artery aneurysm: a case report. Vasc Endovascular Surg 2006; 40:79-83. [PMID: 16456611 DOI: 10.1177/153857440604000112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hepatic artery aneurysms (HAAs) are considered rare. The great improvement in the diagnosis of vascular diseases and the increasing incidence of atherosclerosis have resulted in a wider recognition of these pathologies. Differently from other splanchnic locations, HAAs have a high risk of rupture so that an aggressive treatment is required. Different therapeutic options are currently available: simple ligation of the artery, aneurysm excision with vascular reconstruction, and transcatheter embolization. We describe the usefulness of transcatheter arterial embolization of an 8 cm hepatic artery aneurysm incidentally found on an abdominal computed tomography (CT) scan in an asymptomatic patient.
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Affiliation(s)
- Amit J Dwivedi
- Department of Vascular Surgery, North Shore University and Long Island Jewish Medical Centers, Manhasset, NY 11374, USA.
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29
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Nijhof HW, Willemssen FEJA, Jukema GN. Transcatheter arterial embolization in a hemodynamically unstable patient with grade IV blunt liver injury: is nonsurgical management an option? Emerg Radiol 2005; 12:111-5. [PMID: 16374645 DOI: 10.1007/s10140-005-0460-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2005] [Accepted: 10/28/2005] [Indexed: 11/29/2022]
Abstract
The prevalence of liver injury in patients who have sustained blunt multiple trauma was reported to range from 1 to 8%. Because previous mortality rates were as high as 50-80% for severe hepatic injury, the choice of treatment was under intensive investigation. Whereas nonsurgical management was the standard treatment for the hemodynamically stable patient, there is no consensus on how to treat hemodynamically unstable patients. This report details the case of a patient who sustained blunt multiple trauma, resulting in a grade IV liver injury, graded according to the American Association for the Surgery of Trauma (AAST) Liver Injury Scale. With massive fluid and blood resuscitation, the patient was stable enough to be managed nonsurgically. With transcatheter arterial embolization (TAE), the left and right hepatic arteries were embolized with coils, which allowed for a good recovery. We hypothesize that TAE can be used in the hemodynamically unstable patient who responds to rapid fluid resuscitation and blood transfusion. We caution that there is insufficient evidence until now and would therefore not make any recommendations; however, we would question the need for surgery in unstable patients with this kind of injury in the future.
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Affiliation(s)
- H W Nijhof
- Section of Traumatology, Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300, RC Leiden, The Netherlands
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30
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Finley DS, Hinojosa MW, Paya M, Imagawa DK. Hepatic artery pseudoaneurysm: a report of seven cases and a review of the literature. Surg Today 2005; 35:543-7. [PMID: 15976950 DOI: 10.1007/s00595-005-2987-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Accepted: 10/01/2004] [Indexed: 12/22/2022]
Abstract
PURPOSE To analyze seven cases of hepatic artery pseudoaneurysm (HAP) encountered at our hospital and review the relevant literature. METHODS We searched the computerized medical record database from January 1, 1996, to September 1, 2003, to identify all cases of HAP, which we then reviewed in detail, examining etiology, findings, laboratory data, therapeutic intervention, complications, and outcome. We then compared these findings with those reported in the literature. RESULTS There were five cases of HAP among 18,015 trauma and surgical admissions to the University of California Irvine Medical Center, representing an incidence of 0.03%. There were an additional two cases of HAP among 200 orthotopic liver transplants (OLT). The five HAPs not associated with OLT were preceded by blunt abdominal trauma, liver biopsy, pancreatic pseudocyst, and polyarteritis nodosa, in one patient each, and there was no apparent cause in one patient. Two patients were treated by ligation, and the patients with post-OLT HAP underwent resection and replacement with saphenous bypass grafts. Successful embolization was performed in the other three patients. CONCLUSION Hepatic artery pseudoaneurysm is a rare but dangerous complication of both acute surgical and chronic injury to the hepatic artery. However, early diagnosis and intervention can result in an excellent long-term outcome.
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Affiliation(s)
- David S Finley
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, University of California, Irvine, Orange, CA 92868, USA
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31
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Dambrin C, Marcheix B, Birsan T, Cron C, Muscari F, Suc B, Cérène A, Rousseau H. Posttraumatic pseudoaneurysm of the hepatic artery: treatment with ultrasound-guided percutaneous transhepatic thrombin injection. ACTA ACUST UNITED AC 2005; 59:239-42. [PMID: 16096571 DOI: 10.1097/01.ta.0000171526.24911.b2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Camille Dambrin
- Department of Cardiovascular Surgery, Rangueil Hospital, Toulouse, France.
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32
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Sekino S, Takagi H, Kubota H, Kato T, Matsuno Y, Umemoto T. Intercostal artery pseudoaneurysm due to stab wound. J Vasc Surg 2005; 42:352-6. [PMID: 16102639 DOI: 10.1016/j.jvs.2005.03.058] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 03/31/2005] [Indexed: 11/29/2022]
Abstract
Intercostal artery pseudoaneurysm is extremely rare, and only six cases have been reported in the English literature. We describe a case of intercostal artery pseudoaneurysm due to a stab wound, review the literature, and discuss therapeutic modalities. Intercostal artery pseudoaneurysm is at risk for early rupture, and diagnosis before rupture is mandatory. Although embolization is considered to be a feasible therapeutic method, we would emphasize the significance of the anatomic features of the intercostal arteries: multiple blood supplies into the pseudoaneurysm, such as the anterior and posterior intercostal arteries, and musculophrenic artery.
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Affiliation(s)
- Seishiro Sekino
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Sunto-gun, Japan
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33
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Tzeng WS, Wu RH, Chang JM, Lin CY, Koay LB, Uen YH, Tian YF, Fong Y. Transcatheter arterial embolization for hemorrhage caused by injury of the hepatic artery. J Gastroenterol Hepatol 2005; 20:1062-8. [PMID: 15955215 DOI: 10.1111/j.1440-1746.2005.03768.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aims of the study were to compare (i) the effects of transcatheter arterial embolization on initial hemostasis and the control of rebleeding in the treatment of hemorrhage due to hepatic artery injury; and (ii) the outcomes of embolization by different locations. METHODS Subjects were 32 patients with suspected hepatic artery injury who were transferred to Chi-Mei Foundation Medical Center for hepatic angiography and embolization. The causes of arterial injury included liver trauma (n = 15) and iatrogenic injury (n = 17). The sites of embolization were classified into four groups: group 1 (n = 8) was classified as 'combined outlet, target and inlet control' with embolization of the vascular lesion (target) and hepatic artery distal (outlet) and proximal (inlet) to the vascular lesion simultaneously; group 2 (n = 11) as 'combined target and inlet control'; group 3 (n = 8) as 'combined outlet and inlet control'; group 4 (n = 5) as 'inlet control' only. RESULTS Successful initial hemostasis was achieved in 30 of the 32 patients (93.8%), with two failures, both of which were caused by liver injury and occurred in subjects in group 4. Rebleeding was seen in three patients who had successful initial hemostasis: two of them in group 4 (66.7%) and one in group 1 (12.5%). All rebleedings were successfully managed by repeat embolization. Abscess formation was found in two group 1 patients, and both were successfully managed by percutaneous drainage. CONCLUSIONS Transcatheter arterial embolization is an effective method for hemostasis in hepatic artery hemorrhage for both patients with liver trauma and patients with iatrogenic injuries to the hepatic artery. Based on this experience, embolization of the vascular lesion and/or the arterial lumen distal to the vascular lesion combined with inlet control is recommended for preventing recurrent hemorrhage, but studies with larger sample sizes will be required to validate this conclusion.
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Affiliation(s)
- Wen-Sheng Tzeng
- Department of Radiology, Chi-Mei Foundation Medical Center, Yung Kang City, Tainan County, Taiwan.
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34
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Bruens ML, De Smet A, Vroegindeweij D, Haverlag R, Van Der Harst E. Haemobilia 2 weeks after a low thoracic stab wound. HPB (Oxford) 2005; 7:318-9. [PMID: 18333215 PMCID: PMC2043103 DOI: 10.1080/13651820410033689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Haemobilia occurs in only 1.2-5% of patients with accidental liver trauma. We describe an unusual case 2 weeks after penetrating thoracic injury. CASE OUTLINE A 27-year-old man underwent laparotomy for hepatic bleeding after a low thoracic stab wound. Two weeks later rectal blood loss occurred. CT scan and angiography revealed intrahepatic contrast extravasation at the previous stab wound site. Coils were successfully placed into two branches of the right hepatic artery. DISCUSSION Haemobilia should be considered in patients presenting with gastrointestinal blood loss after liver injury. It is diagnosed with angiography and preferably treated by embolisation.
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Affiliation(s)
- M. L. Bruens
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
| | - Aaea De Smet
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
| | - D. Vroegindeweij
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
| | - R. Haverlag
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
| | - E. Van Der Harst
- Department of Surgery and Interventional Radiology, Medisch Centrum Rijnmond Zuidlocatie ClaraRotterdamThe Netherlands
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35
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Marcheix B, Dambrin C, Cron C, Sledzianowski JF, Aguirre J, Suc B, Cerene A, Rousseau H. Embolisation transhépatique percutanée d’un pseudoanévrisme post-traumatique de l’artère hépatique. ACTA ACUST UNITED AC 2004; 129:603-6. [PMID: 15581823 DOI: 10.1016/j.anchir.2004.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pseudoaneurysm of the hepatic artery is a rare complication of blunt abdominal trauma. We report a case of post-traumatic pseudoaneurysm diagnosed several months after the initial traumatism in a 18-year-old man who presented recurrent abdominal pain. This pseudoaneurysm was successfully treated by association of both classical endovascular treatment and transhepatic percutaneous embolization.
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Affiliation(s)
- B Marcheix
- Service de chirurgie cardiovasculaire, CHU Rangueil, 1, avenue Jean-Poulhes, 31403 Toulouse, cedex, France
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36
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Forlee MV, Krige JEJ, Welman CJ, Beningfield SJ. Haemobilia after penetrating and blunt liver injury: treatment with selective hepatic artery embolisation. Injury 2004; 35:23-8. [PMID: 14728951 DOI: 10.1016/s0020-1383(03)00156-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although traumatic haemobilia is uncommon and occurs in less than 3% of liver injuries, the magnitude of the bleeding may result in life-threatening complications. This study evaluated the efficacy of selective hepatic artery embolisation (HAE) in the control of bleeding in patients with traumatic haemobilia. The demographic, clinical and angiographic data on all patients with traumatic haemobilia were obtained from a prospectively documented database of patients undergoing visceral angiography for liver haemorrhage between 1967 and 2002. During the 36-year period under review, 30 patients were found to have haemobilia on selective hepatic angiography. Ten of these 30 patients had haemobilia due to accidental non-iatrogenic trauma and form the basis of this study. In 8 of the 10 patients haemobilia resulted from penetrating liver injuries and two patients had blunt trauma. The mean delay between the initial injury and the diagnosis of haemobilia was 23.5 (range 1-120) days. The mean blood loss before angiography was 8 (range 3-19) units. Six patients were treated successfully with selective hepatic arterial embolisation, three required surgery and one resolved without any intervention. There were no deaths and no complications resulting in long term sequelae. Traumatic haemobilia is an uncommon but life-threatening complication of liver injury. Selective arterial embolisation is the initial treatment of choice with a substantial rate of success and a low incidence of serious complications.
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Affiliation(s)
- M V Forlee
- Department of Surgery and MRC Liver Research Centre, University of Cape Town and Groote Schuur Hospital, Observatory, 7925 Cape Town, South Africa
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37
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Tessier DJ, Fowl RJ, Stone WM, McKusick MA, Abbas MA, Sarr MG, Nagorney DM, Cherry KJ, Gloviczki P. Iatrogenic hepatic artery pseudoaneurysms: an uncommon complication after hepatic, biliary, and pancreatic procedures. Ann Vasc Surg 2003; 17:663-9. [PMID: 14564553 DOI: 10.1007/s10016-003-0075-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatic artery pseudoaneurysms are uncommon but potentially lethal complications of hepatic, biliary, and pancreatic interventions. To enhance our knowledge about these pseudoaneurysms, we reviewed our institution's experience with the management of these lesions. We reviewed the literature on 136 cases of hepatic artery pseudoaneurysms as well as our experience with 17 patients (excluding patients who were post-transplantation or had suffered abdominal trauma). The causes, pathogenesis, and clinical features were analyzed. Ten women and seven men developed hepatic artery pseudoaneurysms after undergoing hepatic (65%), biliary (30%), or pancreatic procedures (5%). The mean time between initial intervention and diagnosis was 5.7 months (range 7 days-38 months). Rupture occurred in 13 patients (76%). Mean pseudoaneurysm size was 1.9 cm (range 0.7-4 cm). Embolization was successful in 12 of 14 patients (86%). Four patients (24%), including the two who failed embolization, required operative intervention. Postoperative mortality was 25% while postembolization mortality was 14%. One patient was observed, and the aneurysm thrombosed at 72 months follow-up. Mean follow-up was 48 months (range 1-184 months) for 13 of the 14 survivors (93%) (1 patient was lost to follow-up) without any clinical sequela. Hepatic artery pseudoaneurysms are rare. Rupture is common and occurred in 76% of patients. For both ruptured and nonruptured cases angiography with embolization of the pseudoaneurysm is safe and effective. Operative intervention should be reserved for patients for whom embolization fails or for whom it is not feasible.
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Affiliation(s)
- Deron J Tessier
- Department of Surgery, Division of Vascular Surgery, Mayo Clinic Scottsdale, Scottsdale, AZ 85259, USA
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38
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Abbas MA, Fowl RJ, Stone WM, Panneton JM, Oldenburg WA, Bower TC, Cherry KJ, Gloviczki P. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg 2003; 38:41-5. [PMID: 12844087 DOI: 10.1016/s0741-5214(03)00090-9] [Citation(s) in RCA: 206] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We reviewed the Mayo Clinic experience with management and outcome of hepatic artery aneurysms (HAA). METHODS Retrospective review of charts for 306 patients with true visceral aneurysm diagnosed from 1980 to 1998 enabled identification of 36 patients (12%) with HAA. RESULTS Patients with HAA included 23 men and 13 women, with mean age of 62.2 years (range, 20-85 years). Most aneurysms were extrahepatic (78%) and single (92%). Mean aneurysm diameter at presentation was 3.6 cm (range, 1.5-14 cm). Five aneurysms had ruptured (14%), and four were symptomatic (11%). Mortality from rupture was 40%. Of the 9 patients with ruptured or symptomatic aneurysms, 2 patients had multiple HAA, 3 patients had fibromuscular dysplasia, and 2 patients had polyarteritis nodosa. All five HAAs that ruptured were of nonatherosclerotic origin (P =.001). Fourteen patients (39%) underwent elective procedures, including excision with vein graft (n = 7), excision with dacron graft (n = 3), excision alone (n = 2), and percutaneous embolization (n = 2). Two vein grafts and one dacron graft became occluded within 1 year. Nonoperative management was elected in 22 patients (61%) with mean aneurysm diameter 2.3 cm (range, 1.5-5 cm). No complications related to the aneurysm occurred during mean follow-up of 68.4 months (range, 1-372 months). Aneurysm growth was identified in 27%, the greatest being 0.8 cm over 34 months. CONCLUSIONS HAA are at definite risk for rupture (14%). Risk factors for rupture include multiple HAA and nonatherosclerotic origin. Patients with symptomatic aneurysms or any of these risk factors should be considered for intervention.
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Affiliation(s)
- Maher A Abbas
- Department of Surgery, Division of Vascular Surgery, Mayo Clinic Scottsdale, Scottsdale, AR 85259, USA
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39
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Asensio JA, Roldán G, Petrone P, Rojo E, Tillou A, Kuncir E, Demetriades D, Velmahos G, Murray J, Shoemaker WC, Berne TV, Chan L. Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps. THE JOURNAL OF TRAUMA 2003; 54:647-53; discussion 653-4. [PMID: 12707525 DOI: 10.1097/01.ta.0000054647.59217.bb] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grades IV and V complex hepatic injuries are highly lethal. Our objectives were to review experience and identify predictors of outcome and to evaluate the role of angioembolization in decreasing mortality. METHODS This was a retrospective 8-year study of all patients sustaining AAST-OIS grades IV and V hepatic injuries managed operatively. Statistical analysis was performed using univariate and multivariate logistic regression. The main outcome measure was survival. RESULTS The study included 103 patients, with a mean Revised Trauma Score of 5.61 +/- 2.55 and a mean Injury Severity Score of 33 +/- 9.5. Mechanism of injury was penetrating in 80 (79%) and blunt in 23 (21%). Emergency department thoracotomy was performed in 21 (25%). AAST grade IV injuries occurred in 51 (47%) and grade V injuries occurred in 52 (53%). Mean estimated blood loss was 9,414 mL. Overall survival was 43%. Adjusted overall survival rate after emergency department thoracotomy patients were excluded was 58%. Results stratified to AAST-OIS injury grade were as follows: grade IV, 32 of 51 (63%); grade V, 12 of 52 (23%); grade IV versus grade V (p < 0.001) odds ratio, 2.06; 95% confidence interval, 2.72 (1.40-3.04). Logistic regression analysis identified as independent predictors of outcome Revised Trauma Score (adjusted p < 0.0002), angioembolization (adjusted p < 0.0177), direct approach to hepatic veins (adjusted p < 0.0096), and packing (adjusted p < 0.0013). CONCLUSION Improvements in mortality can be achieved with an appropriate operative approach. Angioembolization as an adjunct procedure decreases mortality in AAST-OIS grades IV and V hepatic injuries.
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Affiliation(s)
- Juan A Asensio
- Department of Surgery, University of Southern California Medical Center, Los Angeles 90033-4525, USA.
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40
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Soudack M, Epelman M, Gaitini D. Spontaneous thrombosis of hepatic posttraumatic pseudoaneurysms: sonographic and computed tomographic features. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:99-103. [PMID: 12523615 DOI: 10.7863/jum.2003.22.1.99] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Hepatic artery pseudoaneurysms are rare complications of blunt abdominal trauma. In the past, surgical ligation was the recommended treatment; today, it is embolization. We report a case of a child involved in a motor vehicle collision who had liver lacerations with subsequent development of hepatic artery pseudoaneurysms. In this case, embolization was not performed, and the pseudoaneurysms regressed spontaneously. Spontaneous regression has been reported previously, but its true prevalence is unknown. Our report includes full sonographic and partial computed tomographic (CT) documentation of the lesions during the course of their regression. To the best of our knowledge, this is the first report in the English literature with sonographic depiction of spontaneous thrombosis of a hepatic posttraumatic pseudoaneurysm in a child.
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MESH Headings
- Accidents, Traffic
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Angiography/methods
- Child, Preschool
- Female
- Hepatic Artery
- Humans
- Liver/injuries
- Remission, Spontaneous
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Color
- Wounds, Nonpenetrating/complications
- Wounds, Nonpenetrating/diagnostic imaging
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Affiliation(s)
- Michalle Soudack
- Department of Medical Imaging, Rambam Medical Center, PO Box 9602, Haifa, Israel
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41
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Lefkovitz Z, Cappell MS, Lookstein R, Mitty HA, Gerard PS. Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia. Med Clin North Am 2002; 86:1357-99. [PMID: 12510457 DOI: 10.1016/s0025-7125(02)00080-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Major breakthroughs in catheter, guidewire, and other angiographic equipment currently allow interventional radiologists to diagnose massive life-threatening upper and lower GI hemorrhage and to stop the bleeding safely and effectively using superselective catheterization and microcoil embolization. Similarly, the interventional radiologist can treat acute intestinal ischemia safely and effectively with selective catheterization and papaverine administration and treat chronic mesenteric ischemia by percutaneous angioplasty and stent placement. A multidisciplinary approach, including the gastroenterologist, radiologist, and surgeon, is critical in managing GI bleeding and intestinal ischemia, particularly in patients at high risk or presenting as diagnostic dilemmas.
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Affiliation(s)
- Zvi Lefkovitz
- Department of Radiology, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, NY, USA
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42
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Jeng KS, Sheen IS, Yang FS. Vascular complications in percutaneous transhepatic management of complicated hepatolithiasis with difficult intrahepatic biliary strictures: are they avoidable? Surg Laparosc Endosc Percutan Tech 2002; 12:82-7. [PMID: 11948292 DOI: 10.1097/00129689-200204000-00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Little has been reported about hemobilia in the management of complicated residual or recurrent hepatolithiasis with intrahepatic biliary strictures by percutaneous stricture dilation and percutaneous transhepatic cholangioscopic lithotomy. To analyze retrospectively the incidence, possible factors, and management of hemobilia in such patients, a consecutive series of 177 patients was studied from 1983 to 2001: 90 patients in the early, 7.5-year period and 87 patients in the later period, in which some procedures were modified. Minor hemobilia occurred during percutaneous puncture in 6 patients: 4 (4.4%) in the early period and 2 (2.3%) in the later period. Massive hemobilia developed in 14 patients (15.5%) in only the early period, during stricture dilation, lithotripsy, or lithotomy. Immediate arteriography revealed arterial bleeding (7), extravasation (3), pseudoaneurysm (3), or an undetermined source (1). Transcatheter arterial intervention enabled successful hemostasis. Massive hemobilia is a potential serious complication of percutaneous stricture dilation and percutaneous transhepatic cholangioscopic lithotomy but is avoidable.
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Affiliation(s)
- Kou-Shyang Jeng
- Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
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43
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Baha B, Meyer PG, Brunelle F, Orliaguet G, Michel JL, Carli P. [A case of hepatic pseudoaneurysm treated with percutaneous embolization in a child with multiple trauma]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:786-90. [PMID: 11759319 DOI: 10.1016/s0750-7658(01)00485-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hepatic artery pseudoaneurysms are rare complications of blunt abdominal trauma in children. Diagnosis is frequently delayed and made by splanchnic angiography. Most of the indications for surgical treatment have disappeared after the development of selective catheterization and embolization. We report a case in an 8-year-old pedestrian who was struck by a car and suffered a multiple trauma with a severe blunt abdominal trauma. A severe collapse upon admission commanded immediate laparotomy that depicted a liver fracture with associated jejunal and pancreatic lesions. Recovery was progressive until the 15th postoperative day where an abrupt haemobilia occurred. A CT-scan exploration was performed and revealed a vascular mass lesion in the left lobe of the liver. The performance of a selective angiography confirmed the diagnosis of left artery pseudoaneurysm, but because of technical difficulties, no embolization could be performed by this way. A direct percutaneous puncture and embolization of the aneurysm allowed a complete exclusion of the lesion. Eventually, recovery was complete. This percutaneous technique could be a valuable alternative to classical embolization and could avoid surgical treatment that still carries a high morbidity.
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Affiliation(s)
- B Baha
- Département d'anesthésie-réanimation, hôpital des Enfants Malades-Université Paris V, 149, rue de Sèvres, 75745 Paris, France
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44
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Mahi M, Chellaoui M, Chat L, Achabâan F, Alami D, Najid A, el Hassani M, Benamour-Ammar H. [Post-traumatic hepatic artery pseudoaneurysm. A case report]. Arch Pediatr 2001; 8:720-3. [PMID: 11484454 DOI: 10.1016/s0929-693x(00)00304-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CASE REPORT We report a case of traumatic hepatic artery pseudoaneurysm in a 9-year-old child. The diagnosis was made by duplex sonography and helical CT angiography. Arteriography confirmed and managed the lesion with transcatheter embolization. CONCLUSION The traumatic hepatic artery pseudoaneurysm is an uncommon complication of liver trauma in children whose diagnosis is made by duplex sonography and CT angiography. Endovascular embolotherapy is the treatment of choice.
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Affiliation(s)
- M Mahi
- Service de radiologie pédiatrique, CHU Ibn Sina, Rabat, Maroc.
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45
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Lee FYJ, Lai PBS, Chong KL, Lau WY. Initial failure of angiography to demonstrate a bleeding pancreatic cancer: a case for provocative agents. HPB (Oxford) 2001; 3:231-4. [PMID: 18333021 PMCID: PMC2020618 DOI: 10.1080/136518201753242271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mesenteric angiography is commonly employed in the modern-day investigation of gastro-intestinal bleeding if the bleeding sites cannot be identified by endoscopic means. Angiography is optimally sensitive in the presence of active bleeding. However, vasospasm may occasionally account for a negative study shortly after bleeding. CASE OUTLINE A 70-year-old lady with inoperable carcinoma of the pancreas presented with gastro-intestinal bleeding. Although upper endoscopy visualised active bleeding from the tumour, which had invaded into the duodenum, haemostasis could not be achieved endoscopically. Therefore, mesenteric angiography was arranged. RESULTS The initial angiography failed to demonstrate the bleeding site, which only became obvious on a repeat study, when embolisation was performed to achieve haemostasis. DISCUSSION Vasospasm probably accounted for the initial negative study, as the second angiography was able to demonstrate contrast extravasation without the use of any anticoagulant or thrombolytic agent. It is not our routine to give pharmacological agents to provoke bleeding after a negative angiography, but for selected patients this manoeuvre may turn out to be more cost-effective.
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Affiliation(s)
- FYJ Lee
- Department of Surgery, Chinese University of Hong KongHong Kong
| | - PBS Lai
- Department of Surgery, Chinese University of Hong KongHong Kong
| | - KL Chong
- Department of Surgery, Chinese University of Hong KongHong Kong
| | - WY Lau
- Department of Surgery, Chinese University of Hong KongHong Kong
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46
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González-Abraldes J, Moitinho E, García-Pagán JC, Escorsell A, Salmerón JM, Gilabert R, Real M, Muntanyá X, Bosch J. Selective arterial embolization for life threatening hemobilia after transjugular intrahepatic portosystemic shunt placement. J Hepatol 2001; 34:174-6. [PMID: 11211899 DOI: 10.1016/s0168-8278(00)00015-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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47
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Lefkovitz Z, Cappell MS, Kaplan M, Mitty H, Gerard P. Radiology in the diagnosis and therapy of gastrointestinal bleeding. Gastroenterol Clin North Am 2000; 29:489-512. [PMID: 10836191 DOI: 10.1016/s0889-8553(05)70124-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Major breakthroughs in catheter and guidewire design as well as improvements in angiographic x-ray equipment currently allow interventional radiologists to diagnose massive life-threatening upper and lower GI hemorrhage and to stop the bleeding safely and effectively using superselective catheterization and microcoil embolization. For chronic or recurrent GI bleeding, when endoscopy is unrevealing or equivocal, barium studies, CT scanning, nuclear medicine studies, and angiography can help determine the cause of bleeding. A multidisciplinary approach, including the gastroenterologist, radiologist, and surgeon, is extremely helpful in managing GI bleeding, particularly in high-risk patients or patients presenting as diagnostic dilemmas.
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Affiliation(s)
- Z Lefkovitz
- Department of Radiology, Mount Sinai Medical Center, New York, USA
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48
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Yamakado K, Nakatsuka A, Tanaka N, Takano K, Matsumura K, Takeda K. Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol 2000; 11:66-72. [PMID: 10693716 DOI: 10.1016/s1051-0443(07)61284-6] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the clinical efficacy of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA) for ruptured pseudoaneurysms, which are difficult to control by coil embolization alone. MATERIALS AND METHODS Ruptured pseudoaneurysms developed at the celiac trunk (n = 1), gastroduodenal artery (n = 2), pancreatic arcade (n = 1), hepatic artery (n = 3), renal artery (n = 1), and intercostal artery (n = 1) in nine patients. NBCA was mixed with iodized-oil (1:2) and injected via the 3-F microcatheter under fluoroscopic guidance, after the catheter was advanced close to the pseudoaneurysm. Coil embolization was performed to control blood flow before administration of NBCA in seven patients. NBCA was injected immediately after coil embolization in four patients. Embolization with NBCA was performed for recurrent bleeding that occurred within 1-21 days (mean, 10.7 days) after initial coil embolization in three patients. Two patients with peripheral pseudoaneurysms underwent embolization with NBCA alone. RESULTS The NBCA mixture was visible under fluoroscopy, and was useful in monitoring the embolization process and deciding the endpoint. Embolization was technically successful without major complications in all patients. Pseudoaneurysms and afferent and efferent arteries were eliminated immediately after embolization. Bleeding was stopped after embolization in all cases. Rebleeding did not occur in any patient during their follow-up periods of 0.7-69.5 months (mean, 17.9 months). CONCLUSION Embolization with NBCA is a feasible and useful treatment for ruptured pseudoaneurysms, which are difficult to control by coil embolization alone.
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Affiliation(s)
- K Yamakado
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
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49
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Asensio JA, Demetriades D, Chahwan S, Gomez H, Hanpeter D, Velmahos G, Murray J, Shoemaker W, Berne TV. Approach to the management of complex hepatic injuries. THE JOURNAL OF TRAUMA 2000; 48:66-9. [PMID: 10647567 DOI: 10.1097/00005373-200001000-00011] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complex hepatic injuries American Association for the Surgery of Trauma Organ Injury Scale grades IV and V incur high mortality rate ranging from 40 to 80%, respectively. The objective of this study is to assess the clinical experience with an aggressive approach to the management of these, the most complex of hepatic injuries. METHODS This is a retrospective 6-year study (1992-1997) at an American College of Surgeons urban Level I trauma center of patients sustaining complex hepatic injuries whose interventions included surgery, angiographic embolization, endoscopic retrograde cholangiopancreatography plus biliary stenting and percutaneous computed tomographic-guided drainage. The main outcome measure was survival. RESULTS A total of 22 patients sustaining complex hepatic injuries; mean age of 26 years (range, 10-52 years), mean Revised Trauma Scale score of 9.9, mean Injury Severity Score of 32 (range, 16-75), American Association for the Surgery of Trauma - Organ Injury Scale grade IV (13 cases); grade V (9 cases). Mean estimated blood loss was 4,600 mL; mean number of units of blood transfused was 15. The patients underwent the following interventions: surgery (n = 22), re-operated (n = 13), mean number of operations 1.6 (range, 1-4), extensive hepatotomy and hepatorrhaphy (n = 17), nonanatomic resection (n = 7), formal hepatectomy (n = 4), packing (n = 10), direct approach to hepatic veins (n = 3); angiographic embolization (n = 15); endoscopic retrograde cholangiopancreatography and stenting (n = 5); computed tomographic guided drainage (n = 6). Mean length of stay in the intensive care unit was 21 days (range, 2-134 days), mean hospital length of stay was 40 days (range, 2-147 days). Overall mortality rate was 14% (3 of 22 cases), hepatic mortality rate was 9% (2 of 22 cases), mortality rate by injury grade was 8% grade IV (1 of 13 cases) and 22% grade V (2 of 9 cases). CONCLUSION In this select patient population, improvements in mortality rates can be achieved with an aggressive approach to the management of complex hepatic injuries, including surgery, early packing, angiographic embolization, endoscopic retrograde cholangiopancreatography and stenting of biliary leaks, and drainage of hepatic abscesses.
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Affiliation(s)
- J A Asensio
- Department of Surgery, University of Southern California and the Los Angeles County and University of Southern California Medical Center, 90033-4525, USA.
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50
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Butler KL, Sinclair KE, Silverstein MI, Mesidor DA, Weaver WL. Posttraumatic hemobilia complicated by obstructive jaundice. THE JOURNAL OF TRAUMA 1999; 47:582-4. [PMID: 10498320 DOI: 10.1097/00005373-199909000-00029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K L Butler
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia 30310, USA
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