Nonsurgical management of patients with blunt hepatic injury: efficacy of transcatheter arterial embolization.

OBJECTIVE: We evaluated the efficacy of transcatheter arterial embolization (TAE) for patients with blunt hepatic injury.

SUBJECTS AND METHODS: Of 372 patients with trauma, 60 had evidence on CT of hepatic injury (Mirvis classification). Six of the 60 patients required emergency laparotomy and were excluded. Of the 54 remaining patients, 28 were classified as having high-grade hepatic injury (Mirvis classification of 3 or 4). All 28 underwent arteriography, and TAE was performed in single or multiple hepatic arterial branches when extravasation was seen. Angiography was repeated and cholescintigraphy was performed on patients with continued bleeding or biloma.

RESULTS: Injuries detected were grade 1 (n = 13), grade 2 (n = 13), grade 3 (n = 20), and grade 4 (n = 8). The injury was correlated with the degree of hemoperitoneum seen on CT. Patients with low-grade injuries (Mirvis classification of 1 or 2) were treated conservatively, and no deaths or liver-related morbidity occurred. Of the 28 patients with high-grade injury, 15 also had angiographic evidence of extravasation and underwent TAE. The average fluid resuscitation volume was significantly larger in this group than in the other 13 patients with high-grade injuries who did not undergo TAE. Embolization was successful in all 15 patients, and the shock index was significantly reduced after TAE. All patients survived, with follow-up at 1-8 months (2.5 +/- 1.8 months, mean +/- SD).

CONCLUSION: TAE is an effective alternative to surgery for patients with high-grade liver injury.