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Use of a Postoperative Hepatic Arterial Embolization in Patients with Postoperative Bleeding due to Severe Hepatic Injuries  

Cha, Soo Hyun (Department of Emergency Medicine, Ajou University School of Medicine)
Jung, Yong Sik (Department of Surgery, Ajou University School of Medicine)
Won, Jae Hwan (Department of Radiology, Ajou University School of Medicine)
Kim, Wook Whan (Department of Surgery, Ajou University School of Medicine)
Wang, Hee Jung (Department of Surgery, Ajou University School of Medicine)
Kim, Myung Wook (Department of Surgery, Ajou University School of Medicine)
Lee, Kug Jong (Department of Emergency Medicine, Ajou University School of Medicine)
Publication Information
Journal of Trauma and Injury / v.19, no.1, 2006 , pp. 59-66 More about this Journal
Abstract
Purpose: Acute liver failure after massive partial hepatectomy is critical condition with high mortality. To prevent postoperative liver failure from being induced by a massive partial hepatectomy, many doctors do a minimal resection on the single lobe of the liver that might cause postoperative bleeding from the remaining ruptured parenchyma. The objective of this study was to assess clinical experience with postoperative hepatic arterial embolization to control bleeding from the remaining ruptured liver during the postoperative period. Methods: This retrospective 4-year study was conducted from May 2002 to April 2006 and included consecutive patients who had sustained massive hepatic injuries and who had undergone a laparotomy, followed by postoperative hepatic arterial angiographic embolization to control bleeding. Data on the injury characteristics, the operative treatment and embolization, and the amount of transfused packed red cells (PRBC) were gathered and analyzed. In addition, data on the overall complications and survival rate were collected and analyzed. Results: Every case showed severe liver injury, higher liver injury scaling grade IV. Only ten cases involved a ruptured bilateral liver lobe. A lobectomy was done in 6 cases, a left lobectomy was done in 3 cases, and a primary suture closure of the liver was done in 2 cases. Suture closure was also done on the remaining ruptured liver parenchyma in cases of lobectomies. The postoperative hepatic arterial embolizations were done by using the super-selection technique. There were some cases of arterio-venous malformations and anomalous vessel branches. The average amount of transfused PRBC during 24 hours after embolization was $2.36{\pm}1.75$, which statistically significantly lower than that before embolization. Among the 11 cases, 9 patients survived, and 2 died. There was no specific complications induced by the embolization. Conclusion: In cases of postoperative bleeding in severe hepatic injury, if there is still a large amount of bleeding, postoperative hepatic arterial embolization might be a good therapeutic option.
Keywords
Hepatic arterial embolization; Hepatectomy; Lobectomy;
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1 Asensio JA, Demetriades D, Chahwan S, Gomez H, Hanpeter D, Velmahos G, et al. Approach to the management of complex hepatic injuries. J Trauma 2000;48:66-9   DOI   ScienceOn
2 Sclafani SJ, Shaftan GW, McAuley J, Nayaranaswamy T, Mitchell WG, Gordon DH, et al. Interventional radiology in the management of hepatic trauma. J Trauma 1984;24:256-62   DOI
3 Cogbill TH, Moore EE, Jurkovich GJ, Feliciano DV, Morris JA, Mucha P. Severe hepatic trauma: a multi-center experience with 1,335 liver injuries. J Trauma 1988;28:1433-8   DOI
4 Liu PP, Chen CL, Cheng YF, Hsieh PM, Tan BL, Jawan B, Ko SF. Use of a refined operative strategy in combination with the multidisciplinary approach to manage blunt juxtahepatic venous injuries. J Trauma 2005;59:940-5   DOI   ScienceOn
5 Pretre R, Mentha G, Huber O, Meyer P, Vogel J, Rohner A. Hepatic trauma: risk factors influencing outcome. Br J Surg 1998;75:520-4
6 Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF. Blunt hepatic injury: minimal intervention is the policy of treatment. J Trauma 2000;49:722-8   DOI   ScienceOn
7 Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg. 2000;231:804-13   DOI   ScienceOn
8 Croce MA, Fabian TC,, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients: Results of a prospective trial. Ann Surg. 1995;221:744-53   DOI   ScienceOn
9 Strain AJ. Neuberger JM. A bioartificial liver-state of the art. Science 2002;295:1005-9   DOI
10 Riegler JL, Lake JR. Fulminant hepatic failure. Med Clin North Am 1993;77:1057-83   DOI
11 Blumgart LH. Surgery of the liver and biliary tract. 2nd edition. New York. Churchill livingstone Medical Division of Longman Group, 1994
12 Kim YW, Jung YS, Kim WH, Min YG, Kim KW, Lee KG. Temporary Abdominal coverage with Malex mesh prosthesis in cases of severely injured abdominal trauma patients. J Korean Traumatology 2005;18:70-9
13 Schofield PS, McLees DJ, Myles DD, Sugden MC. Ketone-body metabolism after partial hepatectomy in the rat. Biochem J 1985;231:225-8   DOI
14 Denton JR, Moore EE, Coldwell DM. Multimodality treatment for grade V hepatic injuries: perihepatic packing, arterial embolization, and venous stenting. J Trauma 1997;42:964-8   DOI   ScienceOn
15 Zieve L, Anderson WR, Lindblad S. Course of hepatic regeneration after 80% to 90% resection of normal rat liver. Comparison with two-lobe and onelobe hepatectomy. J Lab Clin Med 1985;105:331-6
16 Schofield PS, French TJ, Sugden MC. Ketone-body metabolism after surgical stress or partial hepatectomy. Evidence for decreased ketogenesis and a site of control distal to carnitine palmitoyltransferase I. Biochem J 1987;241:475-81   DOI
17 Wagner WH, Lundell CJ, Donovan AJ. Percutaneous angiographic embolization for hepatic arterial hemorrhage. Arch Surg 1985;120:1241-9   DOI   ScienceOn
18 Carrillo EH, Spain DA, Wohltmann CD, Schmieg RE, Boaz PW, Miller FB, et al. Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries. J Trauma. 1999;46:619-24   DOI   ScienceOn
19 Cox EF, Flancbaum L, Dauterive AH, Paulson RL. Blunt trauma to the liver. Analysis of management and mortality in 323 consecutive patients. Ann Surg 1988;207:126-34   DOI   ScienceOn
20 Moore EE, Feliciano DV, Mattox KL. Trauma. 5th edition. New York. McGraw-Hill Medical Publishing Division, 2004
21 Bergqvist D, Hedelin H, Karlsson G, Lindblad B, Matzsch T. Abdominal trauma during thirty years: analysis of a large case series. Injury 1981;13:93-9   DOI   ScienceOn
22 Beal SL. Fatal hepatic hemorrhage: an unresolved problem in the management of complex hepatic injuries. J Trauma 1990;30:163-9