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Outcomes and complications of angioembolization for hepatic trauma: A systematic review of the literature

Green, Christopher S. MD, MBA; Bulger, Eileen M. MD; Kwan, Sharon W. MD

Journal of Trauma and Acute Care Surgery: March 2016 - Volume 80 - Issue 3 - p 529–537
doi: 10.1097/TA.0000000000000942
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BACKGROUND The liver is one of the most frequently injured abdominal organs. Hepatic hemorrhage is a complex and challenging complication following hepatic trauma. Significant shifts in the treatment of hepatic hemorrhage, including the increasing use of angioembolization, are believed to have improved patient outcomes. We aimed to describe the efficacy of angioembolization in the setting of acute hepatic arterial hemorrhage as well as the complications associated with this treatment modality.

METHODS A systematic review of published literature (MEDLINE, SCOPUS, and Cochrane Library) describing hepatic angioembolization in the setting of trauma was performed. Articles that fulfilled the predetermined inclusion and exclusion criteria were included. We analyzed the efficacy rate of angioembolization in the setting of traumatic hepatic hemorrhage as well as the complications associated with hepatic angioembolization.

RESULTS Four hundred fifty-nine articles were identified in the literature search. Of these, 10 retrospective studies and 1 prospective study met inclusion and exclusion criteria. Efficacy rate of angioembolization was 93%. The most frequently reported complications following hepatic angioembolization included hepatic necrosis (15%), abscess formation (7.5%), and bile leaks.

CONCLUSION Although the outcomes of hepatic angioembolization were generally favorable with a high success rate, the treatment modality is not without associated morbidity. The most frequently associated major complication was hepatic necrosis. Rates of complications were affected by study heterogeneity and should be better defined in future studies.

LEVEL OF EVIDENCE Systematic review, level III.

From the Department of Radiology (C.S.G.), University of California, Irvine School of Medicine, Orange, California; Division of Trauma and Critical Care (E.M.B.), Department of Surgery, and Interventional Radiology Section (S.W.K.), Department of Radiology, University of Washington Medical Center; and Comparative Effectiveness, Cost, and Outcomes Research Center (S.W.K.), University of Washington, Seattle, Washington.

Submitted: September 3, 2015, Revised: October 22, 2015, Accepted: November 9, 2015, Published online: December 14, 2015.

Address for reprints: Sharon W. Kwan, MD, Interventional Radiology Section, Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St, Seattle, Washington 98195; email: shakwan@uw.edu.

© 2016 Lippincott Williams & Wilkins, Inc.