Relationship between pseudoaneurysm formation and biloma after successful transarterial embolization for severe hepatic injury: permanent embolization using stainless steel coils prevents pseudoaneurysm formation

J Trauma. 2005 Jul;59(1):49-53; discussion 53-5. doi: 10.1097/01.ta.0000171457.18637.69.

Abstract

Objective: The purpose of this study was to determine the association between bilomas and pseudoaneurysm complications after severe hepatic injury.

Methods: Angiography was performed in patients with American Association for the Surgery of Trauma grade > or = III hepatic injury on contrast-enhanced computed tomographic scanning. When contrast extravasation was observed, transarterial embolization (TAE) was performed. After TAE, technetium-99m pyridoxyl-5-methyl-tryptophan cholescintigraphy was performed to detect the coexistence of bilomas. Follow-up angiography was performed when a biloma was detected. Eighty consecutive patients underwent angiography; after angiography, five patients died. The remaining 75 patients who underwent cholescintigraphy were included in this study.

Results: All 11 patients who had bilomas had angiographic evidence of contrast extravasation. The biloma frequency was higher in patients with grades IV and V injuries than in those with grade III injury (p = 0.024). Follow-up angiography revealed pseudoaneurysms in 7 of these 11 patients. All six patients in whom only gelatin sponge pledget injection was used to embolize had pseudoaneurysms. Among them, two patients had computed tomographic evidence of massive intra-abdominal fluid collection. In contrast, only one of five patients who received the combination of gelatin sponge pledget injection and stainless steel coils to permanently embolize injured arteries had a pseudoaneurysm. In this patient, the pseudoaneurysm was found in the peripheral part of the collateral vessels. All patients with pseudoaneurysms underwent repeat TAE and were discharged from the hospital uneventfully.

Conclusion: In patients with high-grade hepatic injury and arterial bleeding who developed biloma, use of a gelatin sponge, an absorbable embolic material, is associated with a risk of pseudoaneurysm formation. Permanent arterial embolization using stainless steel coils is indicated to decrease this risk.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, False / diagnostic imaging
  • Aneurysm, False / prevention & control*
  • Angiography
  • Bile Duct Diseases / diagnostic imaging
  • Bile Duct Diseases / prevention & control*
  • Bile Ducts / injuries*
  • Child
  • Child, Preschool
  • Contrast Media
  • Embolization, Therapeutic*
  • Extravasation of Diagnostic and Therapeutic Materials
  • Female
  • Hepatic Artery / diagnostic imaging
  • Humans
  • Injury Severity Score
  • Liver / injuries*
  • Male
  • Middle Aged
  • Radionuclide Imaging
  • Stainless Steel
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Wounds, Nonpenetrating / diagnostic imaging
  • Wounds, Nonpenetrating / therapy*

Substances

  • Contrast Media
  • Stainless Steel