Nguyen Peter D, Nahmias Jeffry, Aryan Negaar, Samuels Jason M, Cripps Michael, Carmichael Heather, McIntyre Robert, Urban Shane, Burlew Clay Cothren, Velopulos Catherine, Ballow Shana, Dirks Rachel C, Spalding Marchall Chance, LaRiccia Aimee, Farrell Michael S, Stein Deborah M, Truitt Michael S, Grossman Verner Heather M, Mentzer Caleb J, Mack T J, Ball Chad G, Mukherjee Kaushik, Mladenov Georgi, Haase Daniel J, Abdou Hossam, Schroeppel Thomas J, Rodriquez Jennifer, Bala Miklosh, Keric Natasha, Crigger Morgan, Dhillon Navpreet K, Ley Eric J, Egodage Tanya, Williamson John, Cardenas Tatiana C P, Eugene Vadine, Patel Kumash, Costello Kristen, Bonne Stephanie, Elgammal Fatima S, Dorlac Warren, Pederson Claire, Werner Nicole L, Haan James M, Lightwine Kelly, Semon Gregory, Spoor Kristen, Harmon Laura A, Grigorian Areg
Division of Trauma, Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, CA.
Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN.
Surgery. 2025 Feb;178:108909. doi: 10.1016/j.surg.2024.10.002. Epub 2024 Nov 8.
Hepatic angioembolization is highly effective for hemorrhage control in hemodynamically stable patients with traumatic liver injuries and contrast extravasation. However, there is a paucity of data regarding the specific location of angioembolization within the hepatic arterial vasculature and its implications on patient outcomes.
A post-hoc analysis of a multicenter prospective observational study across 23 centers was performed. Adult patients undergoing main hepatic artery angioembolization or segmental hepatic artery angioembolization within 8 hours of arrival were included. The primary outcome was liver-related complications, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. Secondary outcomes were liver-related complication interventions, length of stay, and mortality.
A total of 55 patients underwent hepatic angioembolization, with 23 (41.8%) undergoing main hepatic artery angioembolization and 32 (58.2%) receiving segmental hepatic artery angioembolization. Both groups were comparable in age, vitals, mechanism of injury, liver injury grade distribution, and injury severity score (all P > .05). The main hepatic artery angioembolization group had greater rates of overall liver-related complications (65.2% vs 31.2%, P = .039), specifically perihepatic fluid collection (26.1% vs 6.3%, P = .040) and bile-leak/biloma (34.8% vs 12.5%, P = .048). Main hepatic artery angioembolization had greater rates of 2 or more liver-related complications (47.8% vs 9.4%, P = .001) and readmission within 30 days (30.4% vs 9.4%, P = .046). No significant differences were observed in hospital length of stay and mortality (all P > .05).
Main hepatic artery angioembolization is associated with increased rates of liver-related complications, multiple liver-related complications, and readmission within 30 days compared with segmental hepatic artery angioembolization. Thus, main hepatic artery angioembolization should be reserved for use only when segmental hepatic artery angioembolization is not feasible, albeit with significantly increased morbidity.
肝血管栓塞术对于血流动力学稳定且有造影剂外渗的创伤性肝损伤患者的出血控制非常有效。然而，关于肝动脉血管系统内血管栓塞术的具体位置及其对患者预后影响的数据却很少。
对一项在23个中心开展的多中心前瞻性观察性研究进行事后分析。纳入在到达后8小时内接受肝总动脉血管栓塞术或肝段动脉血管栓塞术的成年患者。主要结局为肝脏相关并发症，定义为肝周积液、胆漏/胆汁瘤、假性动脉瘤、肝坏死和/或肝脓肿。次要结局为肝脏相关并发症干预措施、住院时间和死亡率。
共有55例患者接受了肝血管栓塞术，其中23例（41.8%）接受了肝总动脉血管栓塞术，32例（58.2%）接受了肝段动脉血管栓塞术。两组在年龄、生命体征、损伤机制、肝损伤分级分布和损伤严重程度评分方面均具有可比性（所有P>.05）。肝总动脉血管栓塞术组的总体肝脏相关并发症发生率更高（65.2%对31.2%，P=.039），尤其是肝周积液（26.1%对6.3%，P=.040）和胆漏/胆汁瘤（34.8%对12.5%，P=.048）。肝总动脉血管栓塞术出现2种或更多肝脏相关并发症的发生率更高（47.8%对9.4%，P=.001），且30天内再入院率更高（30.4%对9.4%，P=.046）。在住院时间和死亡率方面未观察到显著差异（所有P>.05）。
与肝段动脉血管栓塞术相比，肝总动脉血管栓塞术与肝脏相关并发症、多种肝脏相关并发症的发生率增加以及30天内再入院率升高相关。因此，仅在肝段动脉血管栓塞术不可行时才应使用肝总动脉血管栓塞术，尽管其发病率会显著增加。
