Non-operative management of arterial liver hemorrhages

A retrospective evaluation of embolotherapy in patients with arterial liver hemorrhages was carried out. Twenty-six patients, ranging in age from 10 d ays to 77 years with active arterial liver hemorrhages, underwent non-surgi cal embolotherapy. Bleeding was attributed to trauma (n = 21), tumor (n = 3 ), pancreatitis (n = 1), or unknown cause (n = 1). Twenty-nine embolization s were performed via a transfemoral (n = 26) or biliary (n = 2) approach. O ne bar Wallstent was placed into the common hepatic artery via to an axilla ry route to cover a false aneurysm due to pancreatitis. Treatment was contr olled in 4 patients by cholangioscopy (n = 2). Prior surgery had failed in 3 patients. Intervention controlled the hemorrhage in 24 of 26 (92 %) patie nts within 24 h. Embolotherapy failed in 1 patient with pancreatic carcinom a and occlusion of the portal vein. In 1 patient with an aneurysm of the he patic artery treated by Wallstent insertion, total occlusion was not achiev ed in the following days, as demonstrated by CT and angiography. However, c olour Doppler flow examination showed no flow in the aneurysm 6 months late r. Complications were one liver abscess, treated successfully by percutaneo us drainage for 10 days, and one gallbladder necrosis after superselective embolization of the cystic artery. Embolization is a effective tool with a low complication rate in the treatment of liver artery hemorrhage even in p atients in whom surgery has failed.