Objectives: Massive hemorrhage is a serious and potentially fatal complication of blunt, iatrogenic and penetrating liver trauma. Surgery is frequently difficult or contraindicated due to multiple comorbidities. A less invasive way of controlling bleeding is usually preferable. We would like to present our experience with the percutaneous interventional treatment of traumatic hepatic lesions.
Methods: Eighteen patients (12 men) ranging in age from 1 to 76 years (mean 37 years) that had life-threatening vascular liver injury were treated by percutaneous transcatheter occlusive therapy. The bleeding was related to traumatic laceration or pseudoaneurysms of the hepatic artery (HA) in all cases (MVA in 11, surgery in 4, needle biopsy in 2 and percutaneous biliary drainage in 1). Hemobilia was present in 7 patients, liver laceration with intraperitoneal bleeding in 5. The remaining patients presented with significant hypotension after needle biopsy (n=2), uncontrolled hemorrhage after endoscopy (n=1) and hepatic tumor resection (n=1), severe drop in the hematocrit following abdominal blunt trauma (n=1) and a suspected pseudoaneurysm after left hepatic lobectomy (n=1). Six patients had diagnostic CT, and all patients underwent diagnostic angiography leading to transcatheter interventions.
Results: Selective diagnostic arteriography demonstrated the vascular lesion in the HA of all patients. The lesion was located in the right HA (n=15), left HA (n=1), proper HA (n=1) and both left and right HA (n=1). Embolic therapy used a combination of Gianturco coils and Gelfoam pledgets (n=10), Gelfoam alone (n=3), coils alone (n=2) blood clot (n=1), n-butyl-cyanoacrilate (n=1) and occluding balloon catheter (n=1). Treatment by embolization was successful in 17 patients obviating surgery. One patient had uncontrolled bleeding following Whipple procedure, despite embolization, surgery was required but was not able to control the bleeding and the patient expired. Another patient with post liver biopsy bleeding, died 12 hours after the procedure due to multiple organ failure, despite bleeding control by embolization.
Conclusions: Transcatheter embolic therapy is an effective method for treatment of post-traumatic hepatic hemorrhage. It allows high-risk patients to be adequately treated without surgery. It is our impression that emergency angiography and transcatheter embolization should be considered in the first line of treatment for acute and massive traumatic hepatic bleeding.