Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study.
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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
Аннотация
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.