Management of post-traumatic vascular malformations of the liver by catheter embolization

Trauma to the liver occasionally produces vascular malformations, usually pseudoaneurysms of the hepatic artery and sometimes arteriovenous fistulas. Hemorrhagic complications, usually in the form of hemobilia, can result, and portal hypertension is a late complication of an arterial-portal vein fistula. The true incidence of these post-traumatic lesions is apparently much higher than previously realized, and they can regress spontaneously. A case is presented in which both complications appeared simultaneously after a stab wound to the liver. Treatment using selective arterial catheterization and embolization with thrombogenic material was successful. The literature on the use of catheter embolization in hepatic trauma is reviewed. We suggest that catheter embolization be added to the standard therapeutic armamentarium for these lesions. Selective catheter embolization is suggested as the initial therapeutic maneuver in treating both of these lesions because of the relatively low morbidity, the great precision available in limiting the area of devascularization and the good expectation of success on the basis of the reported results of this technique in other traumatized organs, as well as the initially promising reports of its use in hepatic lesions. It should be considered at the time of diagnostic arteriography.