Angiographic embolization for liver injuries: low mortality, high morbidity

Angiographic embolization (AE) is a safe and effective method for controlling hemorrhage in both blunt and penetrating liver injuries. Improved survival after hepatic injuries has been documented using a multimodality approach; however, patients still have significant long-term morbidity. This study examines further the role of AE in both blunt and penetrating liver injuries and the outcomes of its use.

The medical records of 37 consecutive patients admitted from 1995 to 2002 to a Level I trauma center who underwent hepatic angiography with the intent to embolize were reviewed. Demographic and clinical information including Injury Severity Score, length of stay, mortality, intra-abdominal complications, admission physiologic variables, and the number and type of abdominal operations performed were collected.

Thirty-seven patients underwent hepatic angiography and 26 patients had hepatic embolization performed. Eleven patients underwent early-AE, immediately after computed tomographic scanning, and 15 underwent late-AE, after liver-related operations or later in their hospital course. There was a 27% mortality rate overall. There were 11 liver-related complications in the 26 embolizations. Excluding the early deaths, the associated morbidity was 58%, which included hepatic necrosis, hepatic abscesses, and bile leaks.

There is increasing adjunctive use of AE in patients managed both operatively and nonoperatively. Intra-abdominal complications are common in these salvaged patients with severe liver injuries. Those patients that underwent early-AE received significantly fewer blood transfusions and more commonly had sterile hepatic collections. Only 26% of patients required liver-related surgery after AE. Therefore, the integration of AE as an adjunctive modality for patients with high-grade liver injuries is a safe and effective therapeutic option.