Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review

  • Simon Roh (Department of Radiology, St. Luke's Hospital, Temple University School of Medicine)
  • Received : 2023.06.14
  • Accepted : 2023.08.02
  • Published : 2023.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Trauma remains a significant healthcare burden, causing over five million yearly fatalities. Notably, the liver is a frequently injured solid organ in abdominal trauma, especially in patients under 40 years. It becomes even more critical given that uncontrolled hemorrhage linked to liver trauma can have mortality rates ranging from 10% to 50%. Liver injuries, mainly resulting from blunt trauma such as motor vehicle accidents, are traditionally classified using the American Association for the Surgery of Trauma grading scale. However, recent developments have introduced the World Society of Emergency Surgery classification, which considers the patient's physiological status. The diagnostic approach often involves multiphase computed tomography (CT). Still, newer methods like split-bolus single-pass CT and contrast-enhanced ultrasound (CEUS) aim to reduce radiation exposure. Concerning management, nonoperative strategies have emerged as the gold standard, especially for hemodynamically stable patients. Incorporating angiography with embolization has also been beneficial, with success rates reported between 80% and 97%. However, it is essential to identify the specific source of bleeding for effective embolization. Given the severity of liver trauma and its potential complications, innovations in diagnostic and therapeutic approaches have been pivotal. While CT remains a primary diagnostic tool, methods like CEUS offer safer alternatives. Moreover, nonoperative management, especially when combined with angiography and embolization, has demonstrated notable success. Still, the healthcare community must remain vigilant to complications and continuously seek improvements in trauma care.

Keywords

References

  1. Martin JG, Shah J, Robinson C, Dariushnia S. Evaluation and management of blunt solid organ trauma. Tech Vasc Interv Radiol 2017;20:230-6.  https://doi.org/10.1053/j.tvir.2017.10.001
  2. Tinkoff G, Esposito TJ, Reed J, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg 2008;207:646-55.  https://doi.org/10.1016/j.jamcollsurg.2008.06.342
  3. Brillantino A, Iacobellis F, Festa P, et al. Non-operative management of blunt liver trauma: safety, efficacy and complications of a standardized treatment protocol. Bull Emerg Trauma 2019;7:49-54.  https://doi.org/10.29252/beat-070107
  4. Chaudhari PP, Rodean J, Spurrier RG, et al. Epidemiology and management of abdominal injuries in children. Acad Emerg Med 2022;29:944-53.  https://doi.org/10.1111/acem.14497
  5. Virdis F, Reccia I, Di Saverio S, et al. Clinical outcomes of primary arterial embolization in severe hepatic trauma: a systematic review. Diagn Interv Imaging 2019;100:65-75.  https://doi.org/10.1016/j.diii.2018.10.004
  6. Wiik Larsen J, Soreide K, Soreide JA, Tjosevik K, Kvaloy JT, Thorsen K. Epidemiology of abdominal trauma: an age- and sex-adjusted incidence analysis with mortality patterns. Injury 2022;53:3130-8.  https://doi.org/10.1016/j.injury.2022.06.020
  7. Song IG, Lee JS, Jung SW, et al. Analysis of abdominal trauma patients using national emergency department information system. J Korean Soc Traumatol 2016;29:116-23.  https://doi.org/10.20408/jti.2016.29.4.116
  8. Salazar GM, Walker TG. Evaluation and management of acute vascular trauma. Tech Vasc Interv Radiol 2009;12:102-16.  https://doi.org/10.1053/j.tvir.2009.08.004
  9. Samuels JM, Urban S, Peltz E, et al. A modern, multicenter evaluation of hepatic angioembolization: complications and readmissions persist. Am J Surg 2020;219:117-22.  https://doi.org/10.1016/j.amjsurg.2019.06.021
  10. Xu H, Jie L, Kejian S, et al. Selective angiographic embolization of blunt hepatic trauma reduces failure rate of nonoperative therapy and incidence of post-traumatic complications. Med Sci Monit 2017;23:5522-33.  https://doi.org/10.12659/MSM.905115
  11. Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg 2018;85:1119-22.  https://doi.org/10.1097/TA.0000000000002058
  12. Coccolini F, Catena F, Moore EE, et al. WSES classification and guidelines for liver trauma. World J Emerg Surg 2016;11:50. 
  13. Stassen NA, Bhullar I, Cheng JD, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012;73(5 Suppl 4):S288-93.  https://doi.org/10.1097/TA.0b013e318270160d
  14. Park KB, You DD, Hong TH, Heo JM, Won YS. Comparison between operative versus non-operative management of traumatic liver injury. Korean J Hepatobiliary Pancreat Surg 2015;19:103-8.  https://doi.org/10.14701/kjhbps.2015.19.3.103
  15. Yu SH, Park SH, Kim JW, et al. Imaging features and interventional treatment for liver injuries and their complications. Taehan Yongsang Uihakhoe Chi 2021;82:851-61.  https://doi.org/10.3348/jksr.2020.0157
  16. Jeavons C, Hacking C, Beenen LF, Gunn ML. A review of split-bolus single-pass CT in the assessment of trauma patients. Emerg Radiol 2018;25:367-74.  https://doi.org/10.1007/s10140-018-1591-1
  17. Catalano O, Lobianco R, Raso MM, Siani A. Blunt hepatic trauma: evaluation with contrast-enhanced sonography: sonographic findings and clinical application. J Ultrasound Med 2005;24:299-310.  https://doi.org/10.7863/jum.2005.24.3.299
  18. Yoon JY, Kim SH, Ahn R, Hwang JC, Hong ES. Comparison of intraperitoneal and retroperitoneal/pelvic contrast extravasation: the characteristics and prognosis of the each patient group with arterial embolization according to the abdominal computed tomography scanning after blunt trauma. J Korean Soc Traumatol 2009;22:199-205. 
  19. Saqib Y. A systematic review of the safety and efficacy of non-operative management in patients with high grade liver injury. Surgeon 2020;18:165-77.  https://doi.org/10.1016/j.surge.2019.07.001
  20. Yu HC. Nonoperative management guideline of liver injury. Korean J Hepatobiliary Pancreat Surg 2007;11:20-5. 
  21. Brooks A, Reilly JJ, Hope C, Navarro A, Naess PA, Gaarder C. Evolution of non-operative management of liver trauma. Trauma Surg Acute Care Open 2020;5:e000551. 
  22. Meyer DE, Mont MT, Harvin JA, Kao LS, Wade CE, Moore LJ. Catheter distances and balloon inflation volumes for the ER-REBOATM catheter: a prospective analysis. Am J Surg 2020;219:140-4.  https://doi.org/10.1016/j.amjsurg.2019.04.019
  23. Coccolini F, Coimbra R, Ordonez C, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg 2020;15:24. 
  24. Inukai K, Uehara S, Furuta Y, Miura M. Nonoperative management of blunt liver injury in hemodynamically stable versus unstable patients: a retrospective study. Emerg Radiol 2018;25:647-52.  https://doi.org/10.1007/s10140-018-1627-6
  25. Boonsinsukh T, Maroongroge P. Effectiveness of transcatheter arterial embolization for patients with shock from abdominopelvic trauma: a retrospective cohort study. Ann Med Surg (Lond) 2020;55:97-100.  https://doi.org/10.1016/j.amsu.2020.04.029
  26. Tamura S, Maruhashi T, Kashimi F, et al. Transcatheter arterial embolization for severe blunt liver injury in hemodynamically unstable patients: a 15-year retrospective study. Scand J Trauma Resusc Emerg Med 2021;29:66. 
  27. Hwang MJ, Lee HK, Choi SJ, Chung SY. Clinical experiences of transarterial embolization after abdominal surgery in trauma patients. Korean J Vasc Endovasc Surg 2012;28:196-201.  https://doi.org/10.5758/kjves.2012.28.4.196
  28. Tan T, Luo Y, Hu J, Li F, Fu Y. Nonoperative management with angioembolization for blunt abdominal solid organ trauma in hemodynamically unstable patients: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2023;49:1751-61.  https://doi.org/10.1007/s00068-022-02054-2
  29. Prichayudh S, Rajruangrabin J, Sriussadaporn S, et al. Trauma Hybrid Operating Room (THOR) shortened procedure time in abdominopelvic trauma patients requiring surgery and interventional radiology procedures. Injury 2023;54:513-8.  https://doi.org/10.1016/j.injury.2022.11.004
  30. Ahn SR, Seo SH, Lee JH, Park CY. Non-operative management with angioembolization of grade IV and V renal injuries in a hybrid emergency room system. J Trauma Inj 2021;34:191-7.  https://doi.org/10.20408/jti.2021.0034
  31. Jang JY, Oh J, Shim H, et al. The need for a rapid transfer to a hybrid operating theatre: do we lose benefit with poor efficiency? Injury 2020;51:1987-93.  https://doi.org/10.1016/j.injury.2020.04.029
  32. Hu J, Albadawi H, Chong BW, et al. Advances in biomaterials and technologies for vascular embolization. Adv Mater 2019;31:e1901071. 
  33. Pal A, Blanzy J, Gomez KJ, Preul MC, Vernon BL. Liquid embolic agents for endovascular embolization: a review. Gels 2023;9:378. 
  34. Bauer JR, Ray CE. Transcatheter arterial embolization in the trauma patient: a review. Semin Intervent Radiol 2004;21:11-22.  https://doi.org/10.1055/s-2004-831401
  35. Xiao N, Lewandowski RJ. Embolic agents: coils. Semin Intervent Radiol 2022;39:113-8.  https://doi.org/10.1055/s-0041-1740939
  36. De la Garza-Ramos C, Salei A, Caridi TM. Nononcologic embolization. Semin Intervent Radiol 2022;39:416-20.  https://doi.org/10.1055/s-0042-1758077
  37. Cadili A, Gates J. The role of angioembolization in hepatic trauma. Am Surg 2021;87:1793-801.  https://doi.org/10.1177/0003134820973729
  38. O'Dell MC, Shah J, Martin JG, Kies D. Emergent endovascular treatment of penetrating trauma: solid organ and extremity. Tech Vasc Interv Radiol 2017;20:243-7.  https://doi.org/10.1053/j.tvir.2017.10.003
  39. Saiga A, Yokota H, Akutsu A, et al. Prediction of common hepatic artery catheter insertion based on celiac trunk morphology. Diagn Interv Radiol 2023;29:161-6.  https://doi.org/10.5152/dir.2022.21010
  40. Tanaka Y, Oosone A, Tsuchiya A. Usefulness of virtual fluoroscopy in emergency interventional radiology. Taehan Yongsang Uihakhoe Chi 2020;81:852-62.  https://doi.org/10.3348/jksr.2020.81.4.852
  41. Pain JA, Heaton ND, Karani JB, Howard ER. Selective arterial embolization for hepatic trauma. Ann R Coll Surg Engl 1991;73:189-93. 
  42. Lucatelli P, Corona M, Argiro R, et al. Impact of 3D rotational angiography on liver embolization procedures: review of technique and applications. Cardiovasc Intervent Radiol 2015;38:523-35.  https://doi.org/10.1007/s00270-014-1023-x
  43. Lopera JE. Embolization in trauma: review of basic principles and techniques. Semin Intervent Radiol 2021;38:18-33.  https://doi.org/10.1055/s-0041-1724015
  44. Sivrikoz E, Teixeira PG, Resnick S, Inaba K, Talving P, Demetriades D. Angiointervention: an independent predictor of survival in high-grade blunt liver injuries. Am J Surg 2015;209:742-6.  https://doi.org/10.1016/j.amjsurg.2014.06.024
  45. Virdis F, Podda M, Di Saverio S, et al. Clinical outcomes of non-operative management and clinical observation in non-angioembolised hepatic trauma: a systematic review of the literature. Chin J Traumatol 2022;25:257-63.  https://doi.org/10.1016/j.cjtee.2022.04.004
  46. Dabbs DN, Stein DM, Scalea TM. Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries. J Trauma 2009;66:621-9.  https://doi.org/10.1097/TA.0b013e31819919f2
  47. Wong YC, Wang LJ, Wu CH, et al. Differences of liver CT perfusion of blunt trauma treated with therapeutic embolization and observation management. Sci Rep 2020;10:19612. 
  48. Di Serafino M, Iacobellis F, Schilliro ML, et al. The technique and advantages of contrast-enhanced ultrasound in the diagnosis and follow-up of traumatic abdomen solid organ injuries. Diagnostics (Basel) 2022;12:435.