Transcatheter arterial embolization for severe blunt liver injury in hemodynamically unstable patients: a 15-year retrospective study

• Published in: Scandinavian journal of trauma, resuscitation and emergency medicine resuscitation and emergency medicine, 2021-07, Vol.29 (1), p.66-66, Article 66
• Main Authors: Tamura, Satoshi, Maruhashi, Takaaki, Kashimi, Fumie, Kurihara, Yutaro, Masuda, Tomonari, Hanajima, Tasuku, Kataoka, Yuichi, Asari, Yasushi
• Format: Article
• Language: English
• Subjects: Abdomen; Angioembolization; Blood pressure; Blood transfusions; Blunt trauma; Care and treatment; Catheters; Embolization; Emergency medical care; Hemodynamics; Hepatic trauma; Injuries; Intravenous therapy; Ischemia; Laparotomy; Liver; Liver diseases; Liver injury; Methods; Mortality; Non-operative management; Original Research; Patient outcomes; Patients; Population; Surgery; Therapeutic embolization; Transcatheter arterial embolization; Trauma; Variables
• ISSN: 1757-7241; 1757-7241
• DOI: 10.1186/s13049-021-00881-7

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 [greater than or equai to]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. Keywords: Hepatic trauma, Liver injury, Blunt trauma, Non-operative management, Angioembolization, Transcatheter arterial embolization, Interventional radiology