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Does mechanism matter: A comparative systematic review of liver embolization in penetrating versus blunt trauma
Kenneth Meza Monge1, Lorenzo E Aragón Conrado, Daniela Fulginiti
1From the Division of GI, Trauma, and Endocrine Surgery, Department of Surgery (K.M.M., J.-P.I.), University of Colorado, Aurora, Colorado; Medical Education Department (L.E.A.C.), Hospital Militar Escuela "Dr. Alejandro Dávila Bolaños," Managua, Nicaragua; Department of Surgery (D.F.), Pontificia Universidad Católica de Argentina, Buenos Aires; Department of Surgery (S.S.D.), Universidad Nacional de Mar del Plata, Mar de la Plata, Argentina; and Department of Surgery (A.V.-G.), Universidad de los Andes, Mérida, Venezuela.
Background:
Angioembolization (AE) has emerged as a key adjunct in the nonoperative management of hepatic trauma; however, its effectiveness and complication rates may differ based on the mechanism of injury. While AE is widely used for both blunt and penetrating hepatic trauma, limited research has directly compared outcomes between these trauma mechanisms. This systematic review addresses this gap by analyzing AE success rates, complications, and patient outcomes based on the mechanism of hepatic trauma.
Methods:
A systematic review was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identifying studies published between 2014 and 2024 through comprehensive database searches. Eligible studies reported AE outcomes in hepatic trauma with comparative data for blunt and penetrating injuries. Primary outcomes included clinical success, rebleeding, mortality, and hepatic-related deaths. Secondary outcomes included complications and length of stay. Weighted means with 95% confidence intervals (CIs) were calculated.
Results:
Eight studies encompassing 7,397 patients met the inclusion criteria (3,980 blunt [53.8%], 3,417 penetrating [46.2%]). Angioembolization showed higher clinical success in blunt trauma (94.1%; 95% CI, 92.8-95.4%) versus penetrating trauma (85.4%; 95% CI, 83.7-87.1%; p < 0.05). Rebleeding was lower in blunt trauma (7.8%; 95% CI, 6.7-8.9%) than penetrating trauma (14.1%; 95% CI, 12.7-15.5%; p < 0.05). Penetrating trauma had higher overall mortality (14.9% vs. 5.7%) and hepatic-related deaths (7.2% vs. 1.9%; p < 0.05 for both). Complications such as hepatic necrosis, abscesses, and bile leaks were more frequent in penetrating injuries ( p < 0.05). Hospital (9.0 vs. 6.7 days) and intensive care unit stays (5.3 vs. 3.8 days) were also significantly longer ( p < 0.05).
Conclusion:
Angioembolization is more effective in blunt hepatic trauma, with higher success rates, fewer complications, and improved survival. We recommend (1) mechanism-specific protocols with enhanced monitoring for penetrating injuries, (2) consideration of surgical adjuncts for high-grade penetrating trauma, and (3) standardizing AE protocols by injury type to improve outcomes.
Level Of Evidence:
Systematic Review/Meta analysis; Level III.
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