Liver Ischemia After Transarterial Embolization for Hepatic Trauma Injury

Area of Science:

• Interventional Radiology
• Hepatobiliary Surgery
• Vascular Imaging

Background:

• Transarterial embolization (TAE) is a standard treatment for traumatic hepatic injuries.
• Hepatic super-selective TAE infrequently leads to ischemia in the treated area.
• Accurate preoperative assessment is crucial for managing hepatic trauma.

Purpose of the Study:

• To report a rare case of hepatic ischemia and necrosis following TAE for traumatic hepatic injury.
• To investigate the etiology of ischemia in segments 6 and 7 in the context of TAE and hepatic vasculature.
• To emphasize the importance of evaluating hepatic vein anatomy in preoperative planning for hepatic interventions.

Main Methods:

• Review of initial CT scan findings showing contrast extravasation.
• Performance of urgent transarterial embolization (TAE).
• Subsequent CT scans to assess post-embolization complications and evaluate hepatic vein and artery anatomy.

Main Results:

• Initial CT revealed significant contrast extravasation, necessitating urgent TAE.
• A second TAE was performed due to persistent bleeding concerns.
• Post-procedure CT scans demonstrated localized ischemia and necrosis in hepatic segments 6 and 7.
• Analysis revealed a common hepatic artery variation and suggested injury to accessory right inferior hepatic veins (IHVs) as the cause of ischemia, unrelated to TAE.

Conclusions:

• Hepatic ischemia and necrosis in this case were attributed to injury of accessory right inferior hepatic veins (IHVs), not the embolization procedure itself.
• The presence of hepatic vein variations necessitates careful preoperative evaluation of hepatic veins, alongside arteries and portal veins.
• Conservative management may be considered for hepatic injuries without arterial extravasation, warranting further research.