1
|
Tamura S, Maruhashi T, Kashimi F, Kurihara Y, Masuda T, Hanajima T, Kataoka Y, Asari Y. Transcatheter arterial embolization for severe blunt liver injury in hemodynamically unstable patients: a 15-year retrospective study. Scand J Trauma Resusc Emerg Med 2021; 29:66. [PMID: 34256826 PMCID: PMC8278697 DOI: 10.1186/s13049-021-00881-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Transcatheter arterial embolization (TAE) is the first-line nonsurgical treatment for severe blunt liver injury in patients, whereas operative management (OM) is recommended for hemodynamically unstable patients. This study investigated the comparative efficacy of TAE in hemodynamically unstable patients who responded to initial infusion therapy. Methods This retrospective study enrolled patients with severe blunt liver injuries, which were of grades III–V according to the American Association for the Surgery of Trauma Organ Injury Scale (OIS). Patients who responded to initial infusion therapy underwent computed tomography to determine the treatment plan. A shock index > 1, despite undergoing initial infusion therapy, was defined as hemodynamic instability. We compared the clinical outcomes and mortality rates between patients who received OM and those who underwent TAE. Results Sixty-two patients were included (eight and 54 who underwent OM and TAE, respectively; mean injury severity score, 26.6). The overall in-hospital mortality rate was 6% (13% OM vs. 6% TAE, p = 0.50), and the hemodynamic instability was 35% (88% OM vs. 28% TAE, p < 0.01). Hemodynamically unstable patients who underwent TAE had 7% in-hospital mortality and 7% clinical failure. Logistic regression analysis showed that the treatment choice was not a predictor of outcome, whereas hemodynamic instability was an independent predictor of intensive care unit stay ≥7 days (odds ratio [OR], 3.80; p = 0.05) and massive blood transfusion (OR, 7.25; p = 0.01); OIS grades IV–V were predictors of complications (OR, 6.61; p < 0.01). Conclusions TAE in hemodynamically unstable patients who responded to initial infusion therapy to some extent has acceptable in-hospital mortality and clinical failure rates. Hemodynamic instability and OIS, but not treatment choice, affected the clinical outcomes.
Collapse
Affiliation(s)
- Satoshi Tamura
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Takaaki Maruhashi
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Fumie Kashimi
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yutaro Kurihara
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tomonari Masuda
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tasuku Hanajima
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yuichi Kataoka
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| |
Collapse
|
2
|
Ye Y, Ren Y, Zeng H, He J, Zhong Z, Wu X. Characterization of Calibrated Gelatin Sponge Particles in a Rabbit Renal Embolization Model. Cardiovasc Intervent Radiol 2019; 42:1183-1191. [PMID: 31044293 DOI: 10.1007/s00270-019-02224-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the level of artery occlusion, degradation periods, tissue response and vessel recanalization of calibrated gelatin sponge particles after segmental renal artery embolization. MATERIALS AND METHODS Superselective embolization of 14 adult rabbits was performed with calibrated gelatin sponge particles (150-350 μm). Two rabbits were killed immediately after the procedure (day 0). One pair of rabbits was killed on each of the following days: 1, 3, 7, 14, 28 and 56. One rabbit from each pair underwent CT angiography before embolization and killing. The pathologic changes of the embolized renal parenchyma and embolic characteristics of calibrated gelatin sponge particles were evaluated histologically and angiographically. RESULTS Calibrated gelatin sponge particles were distally located in interlobular artery with a dense packing on day 0. The level of occlusion paralleled the size of the particles. Partial degradation of the particles was observed on day 3, and complete degradation was observed on day 14. Vessel recanalization was observed through both CTA and histological analysis starting on day 3. Vascular inflammation responding to gelatin sponge particles was mild and subsided with the degradation of the particles. On day 28 and day 56, attenuation of embolized vessels occurred due to marked intimal proliferation, and vascular occlusion developed. CONCLUSIONS Gelatin sponge particles of 150-350 μm produced dense and distal embolization, and were resorbed before day 14 with a mild tissue reaction. Vessel recanalization occurred secondary to the resorption of gelatin sponge particles, but permanent vascular occlusion developed due to marked intimal hyperplasia after day 28.
Collapse
Affiliation(s)
- Yongsheng Ye
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, People's Republic of China
| | - Yimin Ren
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, People's Republic of China
| | - Hanqiang Zeng
- Department of Interventional Therapy, Dongguan People's Hospital, Dongguan, 523059, People's Republic of China
| | - Jianxun He
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, People's Republic of China
| | - Zhiwei Zhong
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, People's Republic of China
| | - Xiaomei Wu
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, People's Republic of China.
| |
Collapse
|
3
|
Philipoff AC, Ramsay D, Weber DG. Acute traumatic renal arteriocalyceal fistula: selective angioembolisation for haemodynamic instability. BMJ Case Rep 2017; 2017:bcr-2016-216795. [PMID: 28052944 DOI: 10.1136/bcr-2016-216795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abdominal angiography with selective arteriography and subsequent embolisation is an accepted management modality in the treatment of selected solid organ injuries following blunt abdominal trauma. This management practice is well established in the haemodynamically stable patient; however, this remains more controversial in haemodynamically compromised patients, though warrants consideration in both cases due to the associated benefits of non-operative management. This case report describes the successful non-operative management of a severe renal injury in a young polytraumatised patient following a high-speed motor vehicle crash. In addition, the rare CT diagnosis and management of an acute traumatic arteriocalcyeal fistula is discussed with a focus on the importance of renal parenchymal preservation.
Collapse
Affiliation(s)
- Adam Carl Philipoff
- Department of Trauma & General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Duncan Ramsay
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Dieter G Weber
- Department of Trauma & General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
4
|
Mousa AY, Abu-Halimah S, Alhalbouni S, Hass SM, Yang C, Gill G, AbuRahma AF, Bates M. Amyloidosis and spontaneous hepatic bleeding, transcatheter therapy for hepatic parenchymal bleeding with massive intraperitoneal hemorrhage: a case report and review of the literature. Vascular 2013; 22:356-60. [PMID: 23929426 DOI: 10.1177/1708538113492725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hepatic hemorrhage can be devastating, especially in patients with underlying hepatic pathology. This is a case report of a 50-year-old man who presented to the emergency room with Stage 3 shock as evidenced by a systolic blood pressure of 90 mmHg, a heart rate of 125 beats per minute, respiration of 32, with delayed capillary refill and agitation. At this time, he was found to have a massive spontaneous intra-abdominal hemorrhage with an advanced stage of amyloidosis with multiple organ malfunctions. The initial diagnosis was based on an abdominal computed tomography scan and the patient was taken expeditiously to a hybrid angiography suite for a celiac angiogram. An intraoperative diagnosis of extravasation from amyloid related vasculopathy was made based on the angiographic appearance of hepatic circulation. Coil embolization of the feeding branch of the bleeder was achieved using the interlock coil system and a completion angiogram was done showing complete cessation of active bleeding. The postoperative phase was uneventful and the patient was discharged home on postoperative day three. His postoperative visit at five months later was unremarkable.
Collapse
Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Shadi Abu-Halimah
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Saadi Alhalbouni
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Stephen M Hass
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Calvin Yang
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Gurpreet Gill
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Ali F AbuRahma
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Mark Bates
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| |
Collapse
|
5
|
Mitsusada M, Nakajima Y, Shirokawa M, Takeda T, Honda H. Non-operative management of blunt liver injury: a new protocol for selected hemodynamically unstable patients under hypotensive resuscitation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:205-11. [PMID: 23878020 DOI: 10.1002/jhbp.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The objective of this study was to evaluate our new protocol for performing non-operative management for selected unstable patients under hypotensive resuscitation using improved diagnostic imaging techniques. METHODS This retrospective study included 77 consecutive patients with blunt liver injury. They were divided into two groups: those treated before and those treated after the revision. Under the new protocol, we attempted to manage the patients non-operatively, usually with angioembolization, including those whose shock improved with fluid resuscitation and continuous loading, permitting the maintenance of a target systolic blood pressure of 80 mmHg. The outcomes of the two groups were evaluated and compared. RESULTS While comparing the groups, although there was no change in the liver-related morbidity and mortality rates, the urgent and overall laparotomy rates and transfusion requirements in 24 h significantly decreased after the protocol revision. While comparing the subgroups of high-grade injury (AAST Grades 3-5), the overall laparotomy rates and transfusion requirements in 24 h significantly decreased after the protocol revision. CONCLUSIONS All the selected unstable patients were successfully managed non-operatively after the protocol revision. The decrease in laparotomy rates and transfusion requirements confirmed the feasibility of our new protocol for these selected patients.
Collapse
Affiliation(s)
- Makoto Mitsusada
- Department of Emergency Medicine, Tokyo Metropolitan Hiroo General Hospital, 2-11-1, Nerima-ku, Tokyo, 179-0072, Japan.
| | | | | | | | | |
Collapse
|
6
|
Tan H, Zhang LY, Guo QS, Yao YZ, Sun SJ, Wang T, Li YC, Xiong KL. "One-stop hybrid procedure" in the treatment of vascular injury of lower extremity. Indian J Surg 2013; 77:75-8. [PMID: 25829721 DOI: 10.1007/s12262-013-0897-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 03/08/2013] [Indexed: 11/29/2022] Open
Abstract
As a new surgical technique, "one-stop hybrid procedure" is rarely applied in trauma patients. This paper aims to explore its role in vascular injury of the lower extremity. Vascular intervention combined with open surgery was performed to treat three cases of vessel injuries of the lower extremity in our hybrid operating room. One patient with stab injury to the left femoral vein was treated by temporary artery blocking after excluding arterial injury by angiography, followed by blocking surgery and debridement and repair of the injured vein. The other two patients with drug addiction history, who were found to have pricking injuries to the femoral artery combined with local infection, were successfully treated by endovascular techniques and open debridement. One-stop hybrid procedure in treating vascular injury patients could simplify the operation procedure, reduce operative risk, and achieve good curative effect.
Collapse
Affiliation(s)
- Hao Tan
- Trauma Center of PLA, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Lian-Yang Zhang
- Trauma Center of PLA, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Qing-Shan Guo
- Trauma Center of PLA, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Yuan-Zhang Yao
- Trauma Center of PLA, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Shi-Jin Sun
- Trauma Center of PLA, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Tao Wang
- Trauma Center of PLA, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Ying-Cai Li
- Trauma Center of PLA, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Kun-Lin Xiong
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| |
Collapse
|
7
|
Hepatic vascular injury: clinical profile, endovascular management and outcomes. Indian Heart J 2012; 65:59-65. [PMID: 23438614 DOI: 10.1016/j.ihj.2012.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/19/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Endovascular management using angiographic embolization (AE) has been widely used with success as non operative management (NOM) in blunt hepatic trauma. We, in a tertiary care hospital in North of India, assess our use of endovascular management in patients of blunt and post operative trauma with active hepatic vascular bleeding and unstable hemodynamics in controlling bleeding. METHODS A retrospective review of inpatients from January 2006 to July 2012 requiring transarterial embolization/stenting for active hepatic vascular bleeding was done. All patients had evidence of ongoing hemorrhage as proved by clinical, laboratory and radiological findings in emergency settings. Angiographic intervention in an interventional suite with ongoing resuscitation was performed following which patients were monitored for morbidity and mortality benefits on intermediate follow up. RESULTS 10 adults and 3 children underwent AE with polyvinyl alcohol particle (PVA)/soft metal coil whereas 1 adult underwent revascularization with a covered stent for arterial bleeding. The mean age of case series was 36.18 ± 20.90 years with a mean liver injury computed tomography (CT) grade of 3.8 ± 0.83 in blunt trauma patients. The mean length of hospital stay was 9.62 ± 7.83 days and the mean follow up period of the group was 25.25 ± 21.02 months. All patients showed significant clinical improvement with prompt endovascular management resulting in no procedure related mortality. CONCLUSION Prompt endovascular management is the modality of choice in comparison to NOM without AE in both pediatric and adult patients with hemodynamically compromised inaccessible intra hepatic vascular trauma.
Collapse
|
8
|
Embolization for Multicompartmental Bleeding in Patients in Hemodynamically Unstable Condition: Prognostic Factors and Outcome. J Vasc Interv Radiol 2012; 23:751-760.e4. [DOI: 10.1016/j.jvir.2012.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 02/15/2012] [Accepted: 02/18/2012] [Indexed: 11/23/2022] Open
|
9
|
Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs. Int J Emerg Med 2011; 4:47. [PMID: 21794108 PMCID: PMC3170179 DOI: 10.1186/1865-1380-4-47] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/27/2011] [Indexed: 11/29/2022] Open
Abstract
Background In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization. Aim The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney. Results The management of blunt abdominal injury has changed considerably. Focused assessment with sonography for trauma (FAST) examination has replaced diagnostic peritoneal lavage as diagnostic modality in the primary survey. MDCT scanning with intravenous contrast is now the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST. One of the current discussions in the literature is whether a whole body MDCT survey should be implemented in the primary survey.
Collapse
|
10
|
Impact of mobile angiography in the emergency department for controlling pelvic fracture hemorrhage with hemodynamic instability. ACTA ACUST UNITED AC 2010; 68:90-5. [PMID: 20065763 DOI: 10.1097/ta.0b013e3181c40061] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Rapid trauma evaluation and intervention without time delay are considered integral to time-efficient management of trauma patients, particularly for those with hemodynamic instability. This study examined the impact of immediate availability of mobile angiography with digital subtraction angiography technology in the emergency department (ED) for hemodynamically unstable multiple trauma patients with pelvic injury. MATERIALS This retrospective review examined a cohort of all blunt trauma patients with pelvic injury who underwent transcatheter arterial embolization (TAE) using mobile angiography by trauma surgeons in the ED. This system was set up on a 24-hour basis with full-time trauma surgeons available in-hospital. Data collected included clinical characteristics, injury severity, resuscitation intervals from admission through to completion of hemostasis, metabolic factors (pH and core body temperature), mortality, and TAE-related complications. RESULTS Subjects comprised 29 patients (hemodynamically stable group, n = 17; hemodynamically unstable group, n = 12) with a median age of 36 years (interquartile range [IQR], 29-53 years). Mean shock index, injury severity score, and trauma and injury severity score were 1.1 +/- 0.5, 32 +/- 12, and 0.79 +/- 0.27, respectively. Median intervals from ED arrival to diagnosis and from diagnosis to starting TAE were 66 minutes (IQR, 42-80 minutes) and 30 minutes (IQR, 25-37 minutes), respectively. Median interval from diagnosis to completion of TAE was 107 minutes (IQR, 93-130 minutes). Physical and anatomic injury statuses were more severe in the hemodynamically unstable group than in the hemodynamically stable group. However, intervals from diagnosis to starting TAE and from diagnosis to completion of hemostasis did not differ significantly between groups. No exacerbations of metabolic factors during resuscitation were identified. Pelvic injury related mortality was 17% and no TAE-related complications were encountered. CONCLUSION Immediate availability of mobile angiography in the ED seems safe and effective for hemodynamically unstable trauma patients with pelvic injury and results in a rapid improvement in resuscitation intervals without leaving the ED. An adequately randomized controlled trial of mobile angiography in this subset of patients, who would seem to derive the most benefit from mobile angiography, would be ideal.
Collapse
|
11
|
Abstract
The nonoperative care of intraabdominal trauma in the polytraumatised patient greatly depends on imaging techniques. The haemodynamically unstable patient should undergo expedient sonography to rule out abdominal haemorrhage. The use of computer tomography (CT) in this difficult patient group is also currently evaluated, however it takes specific amendments to the protocol and institution. In the hemodynamically stable patient however, computer tomography is the modality of choice to evaluate the injured abdomen. Nonoperative treatment can be successful in up to 80% of selected cases. Adjuncts to nonoperative care include embolisation of the spleen and liver in cases of arterial bleeding, and endoscopic retrograde cholangio pancreaticography (ERCP) and stenting for injuries to the biliary tree.
Collapse
Affiliation(s)
- Luke P H Leenen
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
| |
Collapse
|
12
|
Abstract
BACKGROUND Digital subtraction angiography is frequently required in the initial evaluation of trauma patients. We hypothesized that mobile digital subtraction angiography technology directly into the trauma resuscitation area would save time in restoring metabolic derangements for patients with on-going hemorrhage. MATERIALS This is a retrospective review of a cohort of trauma patients treated before and after the direct availability of mobile angiography in the trauma resuscitation room performed by the trauma surgeons. Data collected for comparison-included demographics, hemodynamic variables, metabolic factors (pH and temperature), units of blood administered, and outcomes. RESULTS Mean age, Shock Index, and Injury Severity Score were similar. The interval from the decision to perform transcatheter arterial embolization (TAE) to starting TAE were significantly different (59 minutes +/- 45 minutes vs. 31 minutes +/- 11 minutes, p = 0.001). The other resuscitation intervals were similar. The mean Deltabody temperature from emergency department arrival through completion of TAE between the two groups were significantly different (-1.18 +/- 1.69 vs. -0.08 +/- 1.42, p = 0.026). The mean DeltapH from emergency department arrival through completion of TAE were also significantly different (-0.118 +/- 0.083 vs. 0.028 +/- 0.127, p = 0.001). There were clinically significant correlations between Deltabody temperature and resuscitation interval, and between DeltapH and resuscitation interval. CONCLUSION The introduction of mobile angiography into the trauma resuscitation room and the immediate availability of trained trauma surgeons to perform diagnostic and therapeutic angiographic procedures shortened the time required to restore normal physiology.
Collapse
|
13
|
Affiliation(s)
- Andrew Holden
- Interventional Radiology Services, Auckland City Hospital, New Zealand.
| |
Collapse
|
14
|
Tucker ON, Marriott P, Rela M, Heaton N. Emergency liver transplantation following severe liver trauma. Liver Transpl 2008; 14:1204-10. [PMID: 18668654 DOI: 10.1002/lt.21555] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Liver trauma is a major cause of mortality after major blunt and penetrating abdominal trauma. The need for life-saving emergency hepatectomy and liver transplantation is extremely rare. We report the management of 2 patients who required urgent liver transplantation for liver trauma. One patient developed hepatic failure following global ischemia after a gunshot injury. The second patient developed a severe postreperfusion injury following removal of a perihepatic pack after blunt abdominal trauma. We highlight the difficulties in the management of severe liver trauma with an emphasis on the clinical features, radiological investigations, and surgical treatment of these complex patients.
Collapse
Affiliation(s)
- Olga N Tucker
- Institute of Liver Studies, King's College London School of Medicine, King's College Hospital, London, United Kingdom.
| | | | | | | |
Collapse
|
15
|
Abstract
The therapeutic and diagnostic approach of liver trauma injuries (by extension, of abdominal trauma) has evolved remarkably in the last decades. The current non-surgical treatment in the vast majority of liver injuries is supported by the accumulated experience and optimal results in the current series. It is considered that the non-surgical treatment of liver injuries has a current rate of success of 83-100%, with an associated morbidity of 5-42%. The haemodynamic stability of the patient will determine the applicability of the non-surgical treatment. Arteriography with angioembolisation constitutes a key technical tool in the context of liver trauma. Patients with haemodynamic instability will need an urgent operation and can benefit from abdominal packing techniques, damage control and post-operative arteriography. The present review attempts to contribute to the current, global and practical management in the care of liver trauma.
Collapse
Affiliation(s)
- Leonardo Silvio-Estaba
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | | | | |
Collapse
|
16
|
Monnin V, Sengel C, Thony F, Bricault I, Voirin D, Letoublon C, Broux C, Ferretti G. Place of arterial embolization in severe blunt hepatic trauma: a multidisciplinary approach. Cardiovasc Intervent Radiol 2008; 31:875-82. [PMID: 18247088 DOI: 10.1007/s00270-007-9277-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 08/26/2007] [Accepted: 12/06/2007] [Indexed: 12/01/2022]
Abstract
This study evaluates the efficacy of arterial embolization (AE) for blunt hepatic traumas (BHT) as part of a combined management strategy based on the hemodynamic status of patients and CT findings. From 2000 to 2005, 84 patients were admitted to our hospital for BHT. Of these, 14 patients who had high-grade injuries (grade III [n = 2], grade IV [n = 9], grade V [n = 3]) underwent AE because of arterial bleeding and were included in the study. They were classified into three groups according to their hemodynamic status: (1) unresponsive shock, (2) shock improved with resuscitation, and (3) hemodynamic stability. Four patients (group 1) underwent, first, laparotomy with packing and, then, AE for persistent bleeding. Ten patients who were hemodynamically stable (group 1) or even unstable (group 2) underwent AE first, based on CT findings. AE was successful in all cases. The mortality rate was 7% (1/14). Only two angiography-related complications (gallbladder infarction) were reported. Liver-related complications (abdominal compartment syndrome and biliary complications) were frequent and often required secondary interventions. Our multidisciplinary approach for the management of BHT gives a main role to embolization, even for hemodynamically unstable patients. In this strategy AE is very efficient and has a low complication rate.
Collapse
Affiliation(s)
- Valérie Monnin
- Department of Radiology, CHU A. Michallon, La Tronche, BP 217, Grenoble, 38043, France.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Stuhlfaut JW, Anderson SW, Soto JA. Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel, and mesenteric injury. Semin Ultrasound CT MR 2007; 28:115-29. [PMID: 17432766 DOI: 10.1053/j.sult.2007.01.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Imaging plays a critical role in the evaluation of patients with blunt abdominal trauma. In most institutions, computed tomography (CT) is the modality of choice when evaluating such patients. The purpose of this review is to highlight current techniques in trauma imaging and to review CT findings associated with solid organ, bowel, mesenteric, and diaphragmatic injury. In particular, emphasis is placed on the use of multidetector CT technology (MDCT), especially 64-row detector CT. The role of various techniques, including the use of oral and intravenous contrast, as well as the potential benefit of delayed imaging, is discussed.
Collapse
Affiliation(s)
- Joshua W Stuhlfaut
- Department of Radiology, Boston University Medical Center, Boston, MA 02118, USA
| | | | | |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW Nonoperative management of the spleen has been the conventional approach for dealing with blunt splenic injury in children for 25 years. Following acceptance in the field of pediatric surgery, nonoperative management of blunt injury to the liver and spleen became the template in adult trauma surgery. It has proven to be of unequivocal benefit to the majority of hemodynamically stable pediatric and adult patients who have suffered blunt liver or splenic trauma. Offsetting these gains, has been the presence of failures. RECENT FINDINGS The recent literature has focused on factors which may impact the nonoperative management success or failure rate. These factors include initiation of guidelines, risk of overwhelming postsplenectomy infection, character of clinical judgment, role of computed tomography in detecting associated intraabdominal injuries, the presence of more than one solid organ injury, risk of associated hollow viscus injury, and the drawbacks of angioembolization. SUMMARY Despite the failures of nonoperative management outlined in this review, the approach has been generally successful. Efforts at improving organ salvage rates and diminishing failures with this approach continue. Notwithstanding our enthusiasm to advance this method of patient care, we must avoid imperiling a subpopulation of patients in our attempt to improve nonoperative management success rates.
Collapse
Affiliation(s)
- Dan A Galvan
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
| | | |
Collapse
|