NONSURGICAL MANAGEMENT OF PATIENTS WITH BLUNT HEPATIC-INJURY - EFFICACY OF TRANSCATHETER ARTERIAL EMBOLIZATION

OBJECTIVE. We evaluated the efficacy of transcatheter arterial emboliz ation (TAE) for patients with blunt hepatic injury. SUBJECTS AND METHO DS. Of 372 patients with trauma, 60 had evidence on CT of hepatic inju ry (Mirvis classification). Six of the 60 patients required emergency laparotomy and were excluded. Of the 54 remaining patients, 28 were cl assified as having high-grade he hepatic injury (Mirvis classification of 3 or 4). All 28 underwent arteriography, and TAE was performed in single or multiple hepatic arterial branches when extravasation was se en. Angiography was repeated and cholescintigraphy was performed on pa tients with continued bleeding or biloma. RESULTS, injuries detected w ere grade 1 (n = 13), grade 2 (n = 13), grade 3 (n = 20), and grade 4 (n = 8). The injury was correlated with the degree of hemoperitoneum s een on CT. Patients with low-grade injuries (Mirvis classification of 1 or 2) were treated conservatively, and no deaths or liver-related mo rbidity occurred. Of the 28 patients with high-grade injury, 15 also h ad angiographic evidence of extravasation and underwent TAE. The avera ge fluid resuscitation volume was significantly larger in this group t han in the other 13 patients with high-grade injuries who did not unde rgo TAE. Embolization was successful in all 15 patients, and the shock index was significantly reduced after TAE. All patients survived, wit h followup at 1-8 months (2.5 +/- 1.8 months, mean +/- SD). CONCLUSION . TAE is an effective alternative to surgery for patients with high-gr ade liver injury.