1
|
Endovascular treatment with Viabahn stent-grafts for arterial injury and bleeding at the visceral arteries: initial and midterm results. Jpn J Radiol 2021; 40:202-209. [PMID: 34480719 PMCID: PMC8803681 DOI: 10.1007/s11604-021-01192-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of the study is to evaluate the initial and midterm efficacy and safety of endovascular treatment (EVT) using Viabahn stent-graft (SG) for arterial injury and bleeding (AIB) at the visceral arteries. MATERIALS AND METHODS Consecutive patients with visceral AIB who underwent EVT using Viabahn between January 2017 and February 2021 were retrospectively reviewed. Technical success, clinical success, peripheral organ ischemia, peri-procedural complications, bleeding-related mortality, 30-day mortality, neck length, re-bleeding, endoleaks, and patency of the SGs at 1, 3, 6, and 12 months were evaluated. RESULTS EVT using Viabahn was performed in 14 patients (mean age: 68.6 years; 12 males) and 15 arteries. The technical and clinical success rates were 100%. The rates of peripheral organ ischemia, peri-procedural complications, bleeding-related mortality, and 30-day mortality were all 0%. The mean neck length was 9.9 mm. No endoleaks or re-bleeding occurred during the follow-up (mean: 732 days). The SG patency was confirmed after 1, 3, 6, and 12 months in 78.6%, 78.6%, 78.6%, and 56.1% of the patients, respectively. CONCLUSION EVT using Viabahn for AIB at the visceral arteries was safe and effective. SG occlusions without ischemia often occurred after 12 months.
Collapse
|
2
|
The Role of Angioembolization in Liver Trauma: the 10-Year Retrospective Experience of a Level One Trauma Center. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
3
|
Lee D, Chung BH, Heo SH, Park YJ, Kim DI. Case Report of a Large Common Hepatic Artery Aneurysm. Ann Vasc Surg 2018; 52:316.e11-316.e13. [PMID: 29886208 DOI: 10.1016/j.avsg.2018.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/01/2018] [Indexed: 12/01/2022]
Abstract
Hepatic artery aneurysm is rare, but appropriate treatment is mandatory. We report a 50-year-old woman with an asymptomatic large hepatic artery aneurysm. The aneurysm was found as a result of abdominal computed tomography (CT) performed as a part of the screening. An open surgery was performed due to the size of the aneurysm. Aneurysmectomy was achieved, and the proper hepatic artery was anastomosed with gastroduodenal artery for adequate blood flow to the liver. Adequate hepatic circulation was confirmed postoperatively by duplex ultrasonography and CT. The patient was discharged on the 9th postoperative day.
Collapse
Affiliation(s)
- Dongheon Lee
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeoung-Hoon Chung
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
4
|
Pancreaticoduodenal arcades as salvage route for transarterial embolization of life-threatening hepatic hemorrhage in patients with severe celiac axis stenosis: Case series. Int J Surg Case Rep 2018; 48:5-9. [PMID: 29763851 PMCID: PMC6066468 DOI: 10.1016/j.ijscr.2018.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/21/2018] [Accepted: 03/23/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Various transarterial embolotherapies for different hepatic etiologies are performed through the celiac axis (CA). However, this pathway is not always patent due to the extensive stenosis or occlusion of the origin of CA. In such situations, the pancreaticoduodenal arcades (PDAs) catheterization is the main alternative to gain access to the hepatic arteries as demonstrated in clinical studies. PRESENTATION OF CASE We report two cases of life-threating hepatic hemorrhage indicated for emergency transarterial embolization (TAE). DISCUSSION The massive hemorrhage was due to spontaneous rupture of hepatocellular carcinoma (HCC) in the first case and due to post liver blunt trauma in the second case. Owing to severe stenosis of the origin of CA, PDAs were used as a salvage alternative route for emergency TAE of hepatic arteries. CONCLUSION Endovascular management of massive hepatic hemorrhage in cases of inaccessibility to hepatic arteries through CA is a highly challenging situation in which the technical success depends on the operator experience, choice of the material and anatomical knowledge of hepatic arterial collateral supply.
Collapse
|
5
|
Role of Interventional Radiology in Solid Organ Trauma. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
6
|
Bordlee B, Schiro B, Peña C. Trauma in the Great Vessels: from the Aorta to the Pelvis. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
Chandrasekharan R, Kp S, Moorthy S, Kulkarni C. Traumatic hepatic arteriohepatic venous fistula managed with selective coil embolization: a case report. BJR Case Rep 2017; 3:20150512. [PMID: 30363278 PMCID: PMC6159243 DOI: 10.1259/bjrcr.20150512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 10/10/2016] [Accepted: 10/18/2016] [Indexed: 11/12/2022] Open
Abstract
Hepatic arterioportal fistulae are frequent vascular complications due to neoplasm, trauma and iatrogenic injury. On the other hand, fistulae between the hepatic arteries and hepatic veins (arteriohepatic venous fistula) are rare. We report the case of a 45-year-old male who suffered from a blunt abdominal trauma with abdominal distension. Initial cross-sectional imaging revealed laceration of the right lobe of liver with an arteriovenous fistula and hemoperitoneum. The diagnosis of arteriohepatic venous fistulae was confirmed on digital subtraction angiography (DSA) and treated angiographically with superselective coil embolization. Post-embolization angiogram showed complete occlusion of arteriovenous fistulae. We emphasis on the management part of the fistulae and endovascular treatment.
Collapse
Affiliation(s)
| | - Sreekumar Kp
- Amrita Institute of Medical Sciences and Research Center, Kochin, India
| | - Srikanth Moorthy
- Amrita Institute of Medical Sciences and Research Center, Kochin, India
| | - Chinmay Kulkarni
- Amrita Institute of Medical Sciences and Research Center, Kochin, India
| |
Collapse
|
8
|
Morris CS. Role of Vascular and Interventional Radiology in the Diagnosis and Management of Acute Trauma Patients. J Intensive Care Med 2016. [DOI: 10.1177/088506660201700302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vascular and interventional radiology provides an important service in the diagnosis and management of the acute trauma patient. Historically angiography was used primarily as a diagnostic tool for both vascular and solid organ injuries. However, with technological advances, such as the advent of stents, stent grafts, newer embolization materials and sophisticated delivery devices, micro-catheters, and steerable guide wires, vascular and interventional radiology can now offer definitive treatment in selected cases. Transcatheter embolization can effectively treat acute hemorrhage and is useful in locations that are difficult to access surgically, or when surgical disruption of fascial planes, which may eliminate a tamponade effect, is less desirable. Stents and stent grafts have been used to preserve, rather than sacrifice, an injured blood vessel. In splenic, hepatic, and renal trauma, a trend in nonoperative management has been developed by traumatologists. Transcatheter embolization can increase the success rate of nonoperative management in selected injuries. In general, despite the injury grade, if evidence of ongoing hemorrhage is present, angiography and transcatheter embolization should be considered. Peripheral vascular injuries can be treated with transcatheter embolization or stents and stent grafts. Transcatheter embolization in trauma was first applied to bleeding associated with pelvic fractures and dislocations, and continues to be an important treatment option. Carotid and vertebral artery injuries can now be repaired using stents or stent grafts, although the experience of this treatment strategy is somewhat limited. Likewise, acute traumatic aortic injury has been successfully treated with stent grafts in small series. Conventional catheter thoracic aortography is now used as an adjunctive diagnostic test for indeterminate or questionable findings on noninvasive imaging studies, primarily computed tomography scans of the chest. In summary, vascular and interventional radiology maintains an important role in the diagnosis and management of acute vascular and solid organ injury. The following review illustrates its current status in acute trauma.
Collapse
Affiliation(s)
- Christopher S. Morris
- Department of Radiology, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT,
| |
Collapse
|
9
|
Miyayama S, Yamakado K, Anai H, Abo D, Minami T, Takaki H, Kodama T, Yamanaka T, Nishiofuku H, Morimoto K, Soyama T, Hasegawa Y, Nakamura K, Yamanishi T, Sato M, Nakajima Y. Guidelines on the use of gelatin sponge particles in embolotherapy. Jpn J Radiol 2014; 32:242-50. [PMID: 24510242 DOI: 10.1007/s11604-014-0292-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/17/2014] [Indexed: 12/20/2022]
Abstract
Gelatin sponge (GS) is one of the most widely used embolic agents in interventional procedures. There are four commercially available GS products in Japan; however, the endovascular use of Gelfoam and Spongel is off-label, and Gelpart can only be used for hepatic artery embolization and Serescue can only be used for hemostasis of arterial bleeding. GS has been used for a variety of clinical indications, mainly tumor embolization and stopping massive arterial bleeding. The optimal size and preparation procedure of GS particles differs slightly for each clinical indication. In addition, there is a risk of ischemic and/or infectious complications associated with GS embolization in various situations. Therefore, radiologists should be familiar with not only the preparation and handling of GS particles, but also the disadvantages and potential risks, in order to perform GS embolization safely and effectively.
Collapse
Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1 Wadanaka-cho, Funabashi, Fukui, 918-8503, Japan,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Lynch J, Montgomery A, Shelmerdine S, Taylor J. Ruptured aneurysm of an aberrant left hepatic artery. BMJ Case Rep 2013; 2013:bcr2013201409. [PMID: 24194166 PMCID: PMC3830390 DOI: 10.1136/bcr-2013-201409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although rare, the high mortality associated with visceral artery aneurysms highlights the importance of their prompt diagnosis and treatment. This report details the acute presentation, diagnosis and management of a 51-year-old man with a non-traumatic ruptured aneurysm of an aberrant left hepatic artery. This is just the second case of a rupture of this aberrant artery reported in the literature, and the only one to be treated using endovascular techniques. An up-to-date review of the investigation and surgical/endovascular management of visceral aneurysms in relation to this case is included.
Collapse
Affiliation(s)
- Jeremy Lynch
- Department of General Surgery, St Mary's Hospital, Newport, Isle of Wight, UK
- Nutbourne, West Sussex, UK
| | | | | | - Jeremy Taylor
- Department of Radiology, Frimley Park Hospital, Frimley, Surrey, UK
| |
Collapse
|
11
|
Hardy AH, Phan H, Khanna P, Nolan T, Dong P. Transcatheter treatment of liver laceration from blunt trauma. Semin Intervent Radiol 2013; 29:197-200. [PMID: 23997412 DOI: 10.1055/s-0032-1326929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Blunt hepatic trauma is a fairly common pathology seen in trauma centers. We describe a pediatric patient who suffered blunt hepatic trauma that was managed successfully with a combination of exploratory laparotomy and liver packing, followed by hepatic artery embolization by interventional radiology (IR) after he continued to have significant arterial extravasation. Also discussed are trends in overall blunt hepatic trauma management and the technique of IR management.
Collapse
|
12
|
Vyas S, Ahuja CK, Yadav TD, Khandelwal N. Emergency ultrasound-guided percutaneous embolization of post-traumatic bleeding hepatic artery pseudoaneurysms. MINIM INVASIV THER 2011; 21:372-6. [PMID: 22142183 DOI: 10.3109/13645706.2011.642077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hepatic artery pseudoaneurysm (HAP) is an uncommon but serious complication of blunt trauma abdomen which can be managed by non-surgical interventional methods. We describe the case of a young boy with blunt trauma abdomen having a large hepatic laceration associated with two pseudoaneurysms of the hepatic artery branches. Both these HAPs were successfully managed by percutaneous injection of cyanoacrylate glue under sonographic guidance. A major surgery was thus averted. A brief review of the etiology, diagnosis and management of HAP including the present case is discussed.
Collapse
Affiliation(s)
- Sameer Vyas
- Departments of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | |
Collapse
|
13
|
Tokue H, Takeuchi Y, Sofue K, Arai Y, Tsushima Y. Ultrasound-guided thrombin injection for the treatment of an iatrogenic hepatic artery pseudoaneurysm: a case report. J Med Case Rep 2011; 5:518. [PMID: 22017919 PMCID: PMC3212963 DOI: 10.1186/1752-1947-5-518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/21/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Percutaneous transhepatic portal embolization is often performed to expand the indications for hepatic resection. Various etiologies of hepatic artery pseudoaneurysm have been reported, but regardless of the etiology, hepatic artery pseudoaneurysm is usually managed with an endovascular approach or open surgery, depending on the location and clinical symptomatology. However, it is difficult to manage hepatic artery pseudoaneurysm after percutaneous transhepatic portal embolization, since embolization of the hepatic artery may cause hepatic infarction CASE PRESENTATION A 58-year-old Japanese man with hilar bile duct cancer underwent percutaneous transhepatic portal embolization to expand the indication for hepatic resection. Two days after percutaneous transhepatic portal embolization, our patient suddenly complained of abdominal pain. Contrast-enhanced computed tomography confirmed a pseudoaneurysm arising from a segmental branch of his right hepatic artery. Since embolization of the hepatic arterial branches may cause hepatic infarction, ultrasound-guided thrombin injection therapy was successfully performed for the pseudoaneurysm. CONCLUSION We performed a thrombin injection instead of arterial embolization to avoid hepatic infarction. The rationale of this choice may be insufficient. However, ultrasound-guided percutaneous thrombin injection therapy may be considered as an alternative to percutaneous transarterial embolization or surgical intervention for an iatrogenic hepatic artery pseudoaneurysm.
Collapse
Affiliation(s)
- Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Maebashi, Gunma, Japan.
| | | | | | | | | |
Collapse
|
14
|
Abstract
Since the development of angiography and transcatheter techniques, interventional radiology has played an important role in the management of trauma patients. The ability to treat life-threatening hemorrhage with transcatheter embolization has spared countless patients the morbidity of surgery. Advances in cross-sectional imaging and increases in understanding of which patients will best benefit from embolization promise to further refine the interventional radiologist's role. As the applications of transcatheter therapy broaden to include embolization of unstable patients with solid organ injuries and endovascular repair of major arterial injuries, the interventional radiologist must be increasingly prepared to provide prompt, efficient, and high-quality service.
Collapse
Affiliation(s)
- Jennifer E Gould
- Interventional Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | | |
Collapse
|
15
|
Abstract
The nonoperative management including endovascular treatment of traumatic injuries to most abdominal solid viscera is increasingly gaining acceptance as treatment of choice in a select group of patients. The indications, techniques, and principles of endovascular management of hepatic, splenic, and renal injuries are discussed in this review.
Collapse
Affiliation(s)
- A Rao Chimpiri
- Department of radiology, Oklahoma University of Health Sciences, Oklahoma City, Oklahoma
| | | |
Collapse
|
16
|
Abstract
The spleen and liver are two organs commonly injured in various forms of abdominal trauma. Their relative size, relatively fixed positions, and abundant vascular supply make them prone both to injury and potential sources of catastrophic haemorrhage. With the evolution of computed tomography (CT), there has been a paradigm shift in the management of such injuries from operative to non-operative means. Advances in imaging techniques have also enabled clinicians to observe such patients for development of complications, and when appropriate, utilise the repertoire of interventional radiology techniques available. This review aims to summarise the epidemiology of splenic and hepatic trauma, the mechanisms of trauma and the classifications used in describing these injuries. The role of commonly used imaging modalities, namely ultrasound and CT, both in the acute setting and in observation of these patients for delayed complications is described, and finally a brief description of the current management strategies of such injuries is given.
Collapse
Affiliation(s)
- Mo Malaki
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Metchley Park Lane, Edgbaston, Birmingham, UK
| | - Kamarjit Mangat
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Metchley Park Lane, Edgbaston, Birmingham, UK,
| |
Collapse
|
17
|
Abstract
Interventional radiology (IR) has much to offer in the treatment of the trauma patient and should be integral in multidisciplinary trauma management. Many minimally invasive endovascular techniques are available with a vast amount of evidence to support their successful application. These techniques are both safe and effective and can in many circumstances negate further trauma caused by surgery in this high risk group. IR should not necessarily be considered a direct replacement for surgery as the two can often be synergistic in providing optimal care to many trauma patients. Despite the body of evidence and wealth of experience, IR is often overlooked or thought of late in trauma management when therapies are less effective. This article explores the role of IR and reviews the techniques and evidence behind their use.
Collapse
Affiliation(s)
- Robert G Jones
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK,
| |
Collapse
|
18
|
Abstract
Multidetector CT is very useful in the evaluation of polytrauma patients. MDCT is valuable for the detection and treatment planning of vascular injuries, but it may not be available to hemodynamically unstable patients. Embolization of visceral and parietal branches of the aorta benefits from advances in catheter technology: hydrophilic catheters and microcatheters are very helpful in this context. Resorbable particles (such as gelatin) and coils are the most useful occlusive agents. Endovascular stenting of aortic rupture is nowadays considered in many centers as the best therapeutic option and can be proposed as an alternative to surgery.
Collapse
|
19
|
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
|
20
|
Successful superselective embolization of posttraumatic pseudoaneurysm of replaced hepatic artery in a child with situs inversus totalis. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200708020-00019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
21
|
Dondelinger RF, Trotteur G, Ghaye B. Hemostatic Arterial Embolization in Trauma Victims at Admission. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
22
|
Goffette PP. Imaging and Intervention in Post-traumatic Complications (Delayed Intervention). Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
23
|
Puapong D, Brown CVR, Katz M, Kasotakis G, Applebaum H, Salim A, Rhee P, Demetriades D. Angiography and the pediatric trauma patient: a 10-year review. J Pediatr Surg 2006; 41:1859-63. [PMID: 17101359 DOI: 10.1016/j.jpedsurg.2006.06.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE Although interventional radiology has played an increasing role in the management of adult trauma patients, little has been written regarding its application in the care of the injured child. This study analyzed the indications, results, and complications for angiography in pediatric trauma patients. METHODS A retrospective review of pediatric patients (14 years or younger) admitted to Los Angeles County-University of Southern California Medical Center, Los Angeles, Calif (an urban level I trauma center), over a 10-year period (1993-2003) was performed. Patients who underwent angiography were identified using hospital angiography records, and further information was recorded from the trauma registry and medical records. Variables collected included age, sex, mechanism of injury, and injury severity score (ISS). Angiographic data analyzed included indications, results, therapeutic interventions, and procedure-related complications. RESULTS Twenty-five pediatric trauma patients who underwent angiography were identified (18 boys, 7 girls). The average age was 11 years (range, 1-14 years), with an ISS of 16 +/- 10. Indications for angiography included suspected limb ischemia (n = 9), suspected pelvic (n = 8) or solid organ bleeding (n = 8), suspected aortic injury (n = 6), and expanding hematoma (n = 1). Eleven patients (44%) had an abnormal finding, and 10 of 11 underwent a subsequent therapeutic intervention. There was 1 minor procedure-related complication and no procedure-related mortality. CONCLUSIONS Though used infrequently in pediatric trauma patients, the result of the angiography was abnormal in almost half of the children in this series. An abnormal finding prompted further therapeutic intervention in most cases. Angiography was associated with minimal morbidity and should be considered as a useful and safe adjunct when caring for injured children.
Collapse
Affiliation(s)
- Devin Puapong
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90033, USA
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Hung SC, Chen JD, Tiu CM, Chiou YY, Chang CY. Traumatic hepatic pseudoaneurysm with arterio-hepatic venous fistula: Diagnosis with MDCT angiography. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.injury.2006.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
25
|
Nijhof HW, Willemssen FEJA, Jukema GN. Transcatheter arterial embolization in a hemodynamically unstable patient with grade IV blunt liver injury: is nonsurgical management an option? Emerg Radiol 2005; 12:111-5. [PMID: 16374645 DOI: 10.1007/s10140-005-0460-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2005] [Accepted: 10/28/2005] [Indexed: 11/29/2022]
Abstract
The prevalence of liver injury in patients who have sustained blunt multiple trauma was reported to range from 1 to 8%. Because previous mortality rates were as high as 50-80% for severe hepatic injury, the choice of treatment was under intensive investigation. Whereas nonsurgical management was the standard treatment for the hemodynamically stable patient, there is no consensus on how to treat hemodynamically unstable patients. This report details the case of a patient who sustained blunt multiple trauma, resulting in a grade IV liver injury, graded according to the American Association for the Surgery of Trauma (AAST) Liver Injury Scale. With massive fluid and blood resuscitation, the patient was stable enough to be managed nonsurgically. With transcatheter arterial embolization (TAE), the left and right hepatic arteries were embolized with coils, which allowed for a good recovery. We hypothesize that TAE can be used in the hemodynamically unstable patient who responds to rapid fluid resuscitation and blood transfusion. We caution that there is insufficient evidence until now and would therefore not make any recommendations; however, we would question the need for surgery in unstable patients with this kind of injury in the future.
Collapse
Affiliation(s)
- H W Nijhof
- Section of Traumatology, Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300, RC Leiden, The Netherlands
| | | | | |
Collapse
|
26
|
Finley DS, Hinojosa MW, Paya M, Imagawa DK. Hepatic artery pseudoaneurysm: a report of seven cases and a review of the literature. Surg Today 2005; 35:543-7. [PMID: 15976950 DOI: 10.1007/s00595-005-2987-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Accepted: 10/01/2004] [Indexed: 12/22/2022]
Abstract
PURPOSE To analyze seven cases of hepatic artery pseudoaneurysm (HAP) encountered at our hospital and review the relevant literature. METHODS We searched the computerized medical record database from January 1, 1996, to September 1, 2003, to identify all cases of HAP, which we then reviewed in detail, examining etiology, findings, laboratory data, therapeutic intervention, complications, and outcome. We then compared these findings with those reported in the literature. RESULTS There were five cases of HAP among 18,015 trauma and surgical admissions to the University of California Irvine Medical Center, representing an incidence of 0.03%. There were an additional two cases of HAP among 200 orthotopic liver transplants (OLT). The five HAPs not associated with OLT were preceded by blunt abdominal trauma, liver biopsy, pancreatic pseudocyst, and polyarteritis nodosa, in one patient each, and there was no apparent cause in one patient. Two patients were treated by ligation, and the patients with post-OLT HAP underwent resection and replacement with saphenous bypass grafts. Successful embolization was performed in the other three patients. CONCLUSION Hepatic artery pseudoaneurysm is a rare but dangerous complication of both acute surgical and chronic injury to the hepatic artery. However, early diagnosis and intervention can result in an excellent long-term outcome.
Collapse
Affiliation(s)
- David S Finley
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, University of California, Irvine, Orange, CA 92868, USA
| | | | | | | |
Collapse
|
27
|
Malaisrie SC, Borge MA, Glynn L, Santaniello JM, Esposito TJ, Davis KA, Luchette FA. Combined Percutaneous and Angiographic Thrombosis of a Traumatic Hepatic Artery Pseudoaneurysm in a Child. ACTA ACUST UNITED AC 2005; 59:1025-8. [PMID: 16374299 DOI: 10.1097/01.ta.0000187970.56941.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S Christopher Malaisrie
- Division of Trauma, Critical Care, and Burns, Department of Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois 60153, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Basile A, Saluzzo CM, Lupattelli T, Carbonatto P, Bottari A, Mundo E, Certo A. Nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization. Surg Laparosc Endosc Percutan Tech 2005; 14:268-75. [PMID: 15492656 DOI: 10.1097/00129689-200410000-00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present our experience in the nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization. We treated 6 pseudoaneurysms (5 intrahepatic and 1 of the gastroduodenal artery), 6 vessel lacerations (1 common hepatic artery, 1 right hepatic artery, 1 gastroduodenal artery, 2 pancreatoduodenal, 1 polar intrasplenic artery), 1 arterioportal fistula, and 1 arteriobiliary fistula; all the bleeding lesions were secondary to surgical, endoscopic, or interventional radiologic procedures.
Collapse
Affiliation(s)
- Antonio Basile
- Department of Radiology, Ospedale Ferrarotto, Catania, Italy.
| | | | | | | | | | | | | |
Collapse
|
29
|
van Schaardenburgh P, Steenvoorde P, de Bruïne JF, Viersma JH, Warmenhoven PG. Thrombotic Resolution of a Traumatic Pseudoaneurysm of the Anterior Tibial Artery after External Compression. ACTA ACUST UNITED AC 2003; 55:561-5. [PMID: 14501905 DOI: 10.1097/01.ta.0000031176.56759.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
30
|
Soudack M, Epelman M, Gaitini D. Spontaneous thrombosis of hepatic posttraumatic pseudoaneurysms: sonographic and computed tomographic features. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:99-103. [PMID: 12523615 DOI: 10.7863/jum.2003.22.1.99] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Hepatic artery pseudoaneurysms are rare complications of blunt abdominal trauma. In the past, surgical ligation was the recommended treatment; today, it is embolization. We report a case of a child involved in a motor vehicle collision who had liver lacerations with subsequent development of hepatic artery pseudoaneurysms. In this case, embolization was not performed, and the pseudoaneurysms regressed spontaneously. Spontaneous regression has been reported previously, but its true prevalence is unknown. Our report includes full sonographic and partial computed tomographic (CT) documentation of the lesions during the course of their regression. To the best of our knowledge, this is the first report in the English literature with sonographic depiction of spontaneous thrombosis of a hepatic posttraumatic pseudoaneurysm in a child.
Collapse
MESH Headings
- Accidents, Traffic
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Angiography/methods
- Child, Preschool
- Female
- Hepatic Artery
- Humans
- Liver/injuries
- Remission, Spontaneous
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Color
- Wounds, Nonpenetrating/complications
- Wounds, Nonpenetrating/diagnostic imaging
Collapse
Affiliation(s)
- Michalle Soudack
- Department of Medical Imaging, Rambam Medical Center, PO Box 9602, Haifa, Israel
| | | | | |
Collapse
|
31
|
Baha B, Meyer PG, Brunelle F, Orliaguet G, Michel JL, Carli P. [A case of hepatic pseudoaneurysm treated with percutaneous embolization in a child with multiple trauma]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:786-90. [PMID: 11759319 DOI: 10.1016/s0750-7658(01)00485-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hepatic artery pseudoaneurysms are rare complications of blunt abdominal trauma in children. Diagnosis is frequently delayed and made by splanchnic angiography. Most of the indications for surgical treatment have disappeared after the development of selective catheterization and embolization. We report a case in an 8-year-old pedestrian who was struck by a car and suffered a multiple trauma with a severe blunt abdominal trauma. A severe collapse upon admission commanded immediate laparotomy that depicted a liver fracture with associated jejunal and pancreatic lesions. Recovery was progressive until the 15th postoperative day where an abrupt haemobilia occurred. A CT-scan exploration was performed and revealed a vascular mass lesion in the left lobe of the liver. The performance of a selective angiography confirmed the diagnosis of left artery pseudoaneurysm, but because of technical difficulties, no embolization could be performed by this way. A direct percutaneous puncture and embolization of the aneurysm allowed a complete exclusion of the lesion. Eventually, recovery was complete. This percutaneous technique could be a valuable alternative to classical embolization and could avoid surgical treatment that still carries a high morbidity.
Collapse
Affiliation(s)
- B Baha
- Département d'anesthésie-réanimation, hôpital des Enfants Malades-Université Paris V, 149, rue de Sèvres, 75745 Paris, France
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
This article focuses on the origin, diagnosis, and management of focal benign lesions of the liver. The most common lesions include cavernous hemangioma, focal nodular hyperplasia, hepatic adenoma, and nodular regenerative hyperplasia. A number of less frequent occurring lesions are also discussed. In general, the common lesions can be diagnosed by radiologic imaging, but occasionally biopsies are required, and surgical removal is often needed.
Collapse
Affiliation(s)
- J F Trotter
- University of Colorado Health Sciences Center, Division of Gastroenterology/Hepatology, Denver, Colorado, USA
| | | |
Collapse
|
33
|
Abstract
Interventional radiology has assumed an expanded role in the management of the pediatric trauma patient. Transcatheter endovascular embolization for the polytraumatized and bleeding patient has proven to be effective and potentially life saving. Nonvascular interventional techniques can be applied to the pediatric trauma patient with curative or temporizing effects. The minimally invasive nature and rapidity of these procedures allows their emergent use in both the unstable and stable pediatric trauma patient.
Collapse
Affiliation(s)
- R Christensen
- Department of Radiology, Memorial Hospital, 1400 E Boulder, Colorado Springs, CO 80909, USA
| |
Collapse
|
34
|
Poletti PA, Mirvis SE, Shanmuganathan K, Killeen KL, Coldwell D. CT criteria for management of blunt liver trauma: correlation with angiographic and surgical findings. Radiology 2000; 216:418-27. [PMID: 10924563 DOI: 10.1148/radiology.216.2.r00au44418] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the contrast material-enhanced computed tomographic (CT) criteria for selection of hemodynamically stable patients with blunt hepatic injury for angiographic evaluation. MATERIALS AND METHODS Seventy-two patients with blunt liver injury underwent CT and hepatic angiography. Hepatic injuries were graded with CT-based classification. Scans were assessed for evidence of contrast extravasation and laceration or contusion extending into the hepatic vein(s), inferior vena cava, porta hepatis, or gallbladder fossa. Medical, angiographic, and surgical records were reviewed to determine angiographic findings, surgical indications and findings, and outcomes. RESULTS Compared with hepatic angiography, CT was 65% (11 of 17 patients) sensitive and 85% (41 of 48 patients) specific for detection of arterial vascular injury. When CT severity grades 2 and 3 were analyzed, the sensitivity and specificity of CT were 100% (three of three patients) and 94% (34 of 36 patients), respectively (P <.001). Injury involving at least one major hepatic vein was found in 15 (88%) of 17 patients who required liver-related surgery and in 23 (42%) of 55 of the other patients (P <.01). CONCLUSION CT-based criteria, including hepatic injury grade, signs of arterial vascular injury, and presence or absence of major hepatic venous involvement assists in selecting patients for hepatic angiography and those at increased risk of ongoing or delayed hepatic bleeding or other posttraumatic complications.
Collapse
Affiliation(s)
- P A Poletti
- Departments of Diagnostic Radiology, University of Maryland Medical Center and Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201, USA
| | | | | | | | | |
Collapse
|
35
|
Special Exhibit for the SCVIR Annual Meeting Film Panel Session: Diagnosis and Discussion of Case 5. J Vasc Interv Radiol 1999. [DOI: 10.1016/s1051-0443(99)70097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
|
36
|
Kohler H, Braunschweig M, Triller J, Cerny A. Sudden abdominal pain and jaundice in a young man. Hosp Pract (1995) 1998; 33:139-40, 143. [PMID: 9826963 DOI: 10.1080/21548331.1998.11443784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- H Kohler
- Department of Medicine, University Hospital, Bern, Switzerland
| | | | | | | |
Collapse
|
37
|
Emergent transcatheter embolization of massive hepatic hemorrhage. Emerg Radiol 1998. [DOI: 10.1007/bf02749147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
38
|
Abstract
Information provided by CT scan allows for determination of the extent of liver injury and identification of other nonhepatic abdominal injuries. This information, coupled with clinical assessment, can be used to optimize management. Contrast-enhanced CT scan can monitor progression or resolution of hepatic injuries, detect complications, and guide percutaneous treatment of some complications. This article discusses CT scanning technique; classification, sites, and mechanisms of liver injury; CT scan appearance of liver injury; and complications of hepatic trauma.
Collapse
Affiliation(s)
- K Shanmuganathan
- Department of Diagnostic Radiology, University of Maryland Medical System, Baltimore, USA
| | | |
Collapse
|
39
|
Cushing BM, Clark DE, Cobean R, Schenarts PJ, Rutstein LA. Blunt and penetrating trauma--has anything changed? Surg Clin North Am 1997; 77:1321-32. [PMID: 9431342 DOI: 10.1016/s0039-6109(05)70620-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Management of abdominal trauma has changed significantly in the last decade. The next decade will also see significant change as imaging and minimally invasive surgical techniques evolve and more approaches are examined in well-designed prospective studies.
Collapse
Affiliation(s)
- B M Cushing
- Department of Surgery, Maine Medical Center, Portland, USA
| | | | | | | | | |
Collapse
|
40
|
|
41
|
Current Management of Abdominal Trauma. J Vasc Interv Radiol 1997. [DOI: 10.1016/s1051-0443(97)70082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
42
|
DiGiacomo JC, McGonigal MD, Haskal ZJ, Audu PB, Schwab CW. Arterial bleeding diagnosed by CT in hemodynamically stable victims of blunt trauma. THE JOURNAL OF TRAUMA 1996; 40:249-52. [PMID: 8637073 DOI: 10.1097/00005373-199602000-00012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although the presence of intra-abdominal blood is a common finding on abdominal computed tomography (CT) scans performed for trauma, acute intra-abdominal bleeding is rarely diagnosed by CT. A focal area of high-density contrast, as compared to the surrounding fluid and tissues, is the characteristic CT finding associated with acute intra-abdominal bleeding and should prompt immediate intervention.
Collapse
Affiliation(s)
- J C DiGiacomo
- Division of Traumatology and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
| | | | | | | | | |
Collapse
|
43
|
Rivitz SM, Waltman AC, Kelsey PB. Embolization of an hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Cardiovasc Intervent Radiol 1996; 19:43-6. [PMID: 8653746 DOI: 10.1007/bf02560147] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Vascular injuries during laparoscopic cholecystectomy can occur in an analogous fashion to biliary injuries, with potential laceration, transection, and occlusion of blood vessels. A patient presented with symptomatic hemobilia 1 month following laparoscopic cholecystectomy and was found to have a right hepatic artery pseudoaneurysm which communicated with the common bile duct. This was successfully embolized with several embolic agents, resulting in rapid resolution of all signs and symptoms. The patient has been free of symptoms during a follow-up period of 1 year. A brief discussion of hepatic artery pseudoaneurysms is presented.
Collapse
Affiliation(s)
- S M Rivitz
- Division of Vascular Radiology, Massachusetts General Hospital, Boston 02114, USA
| | | | | |
Collapse
|
44
|
Tharp RW, Fillmore DJ. Multiple hepatic hemorrhagic mycotic pseudoaneurysms treated with embolization. J Vasc Interv Radiol 1995; 6:876-8. [PMID: 8850663 DOI: 10.1016/s1051-0443(95)71206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- R W Tharp
- Veteran's Administration Medical Center, Salt Lake City, Utah, USA
| | | |
Collapse
|
45
|
Hidalgo F, Narváez JA, Reñé M, Domínguez J, Sancho C, Montanyà X. Treatment of hemobilia with selective hepatic artery embolization. J Vasc Interv Radiol 1995; 6:793-8. [PMID: 8541686 DOI: 10.1016/s1051-0443(95)71187-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate retrospectively the results of selective transcatheter embolization in the treatment of hemobilia. PATIENTS AND METHODS Twelve patients with hemobilia (mean age, 43 years) underwent embolotherapy. Causes of hepatic vascular injury were iatrogenic trauma, blunt external trauma, septic emboli, and lupus vasculitis. A 5-F cobra catheter or a 5-F non-tapered Simmons shaped catheter passed over a hydrophilic guide wire, or a Tracker 18 catheter forming a coaxial system was used. Embolic agents included gelatin sponge or polyvinyl alcohol fragments used alone or with coils. RESULTS Hepatic artery pseudoaneurysms were found in 10 patients, ruptured hepatic artery aneurysm was found in one, and arterioportal fistula was found in two (with pseudoaneurysm in one). Bleeding was immediately controlled in 11 of 12 patients after embolization; one patient rebled and underwent surgery. Two patients underwent repeat embolization (2 weeks and 2 months later). Two patients died, one of biliary sepsis and liver insufficiency 24 hours after embolization and the other of gangrenous cholecystitis. CONCLUSION Transcatheter embolization is an effective treatment of hemobilia. It allows control of bleeding and identification of the origin of the hemorrhage.
Collapse
Affiliation(s)
- F Hidalgo
- Department of Diagnostic Radiology, Ciutat Sanitària i Universitària de Bellvitge, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|