The need for early angiographic embolization in blunt liver injuries

J Trauma. 2002 Jun;52(6):1097-101. doi: 10.1097/00005373-200206000-00012.


Background: Although nonoperative management of blunt liver injury (BLI) has become standard practice, adjuncts to nonoperative therapy, such as angiographic embolization, have not been well characterized.

Methods: Patients with BLI were retrospectively identified at our American College of Surgeons-verified Level I trauma center from January 1997 through February 2001. Patients were stratified into four groups: those who received angiographic embolization (AE) as an early intervention when BLI was initially diagnosed (EARLY-AE); those who underwent AE after liver-related operation or later in the hospital course (LATE-AE); those treated with operation only (OR-ONLY); and nonoperative patients who also did not undergo AE (NO-OR).

Results: There were 126 patients with BLI, of whom 94 were NO-OR, 20 were OR-ONLY, 6 had LATE-AE, and 6 had EARLY-AE. The NO-OR group had significantly lower liver Abbreviated Injury Scale scores. Liver Abbreviated Injury Scale scores were not different between the EARLY-AE, LATE-AE, and OR-ONLY groups. Liver-related mortality was not lower for those treated with AE. There was a trend toward lower mortality for just the EARLY-AE group compared with the LATE-AE and OR-ONLY groups (0% vs. 50% and 35%). The number of units of packed red blood cells transfused and the number of liver-related operations were lower in the EARLY-AE compared with the LATE-AE group, but liver-related complications were not different between the EARLY-AE, LATE-AE, or OR-ONLY groups. AE was successful in arresting hemorrhage in 83% of the cases.

Conclusion: In this small series, we observed similar morbidity and mortality with AE compared with operative therapy. EARLY-AE did decrease blood use and the number of liver-related operations. AE can be performed on severely injured patients with comparable liver-related mortality and complications. Further study of the timing of and outcomes from AE is needed.

MeSH terms

  • Adult
  • Embolization, Therapeutic*
  • Extravasation of Diagnostic and Therapeutic Materials
  • Female
  • Hepatic Veins / diagnostic imaging
  • Humans
  • Injury Severity Score
  • Liver / injuries*
  • Male
  • Michigan
  • Middle Aged
  • Radiography
  • Registries
  • Retrospective Studies
  • Trauma Centers
  • Treatment Outcome
  • Wounds, Nonpenetrating / classification
  • Wounds, Nonpenetrating / surgery
  • Wounds, Nonpenetrating / therapy*