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Hepatic angiography in patients undergoing damage control laparotomy
Jon W Johnson1, Vicente H Gracias, Rajan Gupta
1Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
The Journal of Trauma
|June 5, 2002
Summary
Hepatic angiography is a safe and effective procedure for controlling severe liver bleeding in patients undergoing damage control surgery. This interventional radiology technique showed a high therapeutic success rate with no complications in trauma patients.
Area of Science:
- Trauma surgery
- Interventional radiology
- Hepatobiliary surgery
Background:
- Patients undergoing damage control (DC) laparotomy require aggressive resuscitation and may need interventions for parenchymal liver bleeding.
- Significant liver injuries pose a high risk of arterial bleeding, often necessitating hepatic angiography alongside packing.
- The safety of hepatic angiography in the DC population for penetrating and blunt trauma requires further investigation.
Purpose of the Study:
- To review the experience with hepatic angiography in patients undergoing damage control laparotomy.
- To determine the safety and efficacy of hepatic angiography in managing liver bleeding within the DC trauma population.
Main Methods:
- A 3-year retrospective review of 37 DC patients was conducted.
- Patients with hepatic trauma undergoing angiography were compared to those who did not.
- Data collected included injury mechanism, demographics, injury severity, physiological parameters, resuscitation volumes, and complications.
Main Results:
- Nineteen patients had hepatic trauma and underwent perihepatic packing; 9 underwent angiography, with 8 being hepatic artery angiograms.
- Six patients (75%) had successful embolization of bleeding hepatic vessels.
- No significant differences in physiological parameters or fluid requirements were observed between groups; no angiography-related complications occurred.
Conclusions:
- Hepatic angiography is a safe adjunct to damage control principles for managing liver trauma.
- The procedure demonstrates a high therapeutic ratio with no significant adverse effects in this cohort.