Non-Operative Management of Hepatic Parenchymal and Vascular Injuries: A Departmental Review

Background: Life threatening conditions like gastrointestinal bleeding is a medical emergency which require an intervention to control the bleeding. Conventionally, surgical method was opt to manage such patients but high mortality and morbidity rates of 10%-20% convinced the health care workers to switch to some relatively safer and less invasive method to manage hemorrhagic conditions. Advent of non-operative management i.e. arterial embolization for blunt hepatic injuries in around late 20th century emerged as an operative intervention in controlling bleeding. Arterial embolization is becoming a standard first-line treatment option for the management of hemodynamically unstable patients with acute arterial bleeding from all sources. Minimally invasive percutaneous technique offers treatment for arterial lesions that were previously considered inoperable or deemed to require extensive surgical dissection and/or reconstruction, associated with high morbidity and mortality. Mortality increases substantially if emergency surgery is required for aneurysm rupture. Interventional radiology techniques are being used increasingly to treat pseudo aneurysms, and in most centers, they are the first line of treatment. The success of interventional radiology treatment is dependent on high quality cross sectional pre-procedural imaging and adequately trained vascular interventional radiologists. Interventional radiology has proven to be highly suited to this type of condition, thanks to reduced invasiveness, high success rate and lower risk of complications. Method(s): A retrospective review of cases of hepatic arterial angioembolization performed in our department during 8-year period was performed. Sixty vascular angiographies were performed in 56 patients (45 males and 11 females, age range 12-66 years) who were referred with hemorrhagic hepatic and vascular emergencies to Aga Khan University hospital’s angiography suite from December 2007 to December 2015. Data on clinical indication, technique, site and type of bleeding lesions was obtained from a retrospective review of medical records. Success rate, clinical outcome and complications of the procedure were analyzed. Result(s): Fifty six patients underwent angioembolization in our department during this period. Most of them had computerized axial tomographic (CT) scan followed by HA. Active extravasation and pseudoaneurysm formation was seen in most with a few showing arteriovenous malformation, tumoral blush or laceration. Conclusion(s): Hepatic arterial angio embolization is a safe, effective and lifesaving therapeutic tool for managing liver parenchymal and related vascular emergencies in hemodynamically stable patients.

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Artikel online veröffentlicht:
11. Mai 2021