Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study

Peter D Nguyen; Jeffry Nahmias; Negaar Aryan; Jason M Samuels; Michael Cripps; Heather Carmichael; Robert McIntyre Jr; Shane Urban; Clay Cothren Burlew; Catherine Velopulos; Shana Ballow; Rachel C Dirks; Marchall Chance Spalding; Aimee LaRiccia; Michael S Farrell; Deborah M Stein; Michael S Truitt; Heather M Grossman Verner; Caleb J Mentzer; T J Mack; Chad G Ball; Kaushik Mukherjee; Georgi Mladenov; Daniel J Haase; Hossam Abdou; Thomas J Schroeppel; Jennifer Rodriquez; Miklosh Bala; Natasha Keric; Morgan Crigger; Navpreet K Dhillon; Eric J Ley; Tanya Egodage; John Williamson; Tatiana C P Cardenas; Vadine Eugene; Kumash Patel; Kristen Costello; Stephanie Bonne; Fatima S Elgammal; Warren Dorlac; Claire Pederson; Nicole L Werner; James M Haan; Kelly Lightwine; Gregory Semon; Kristen Spoor; Laura A Harmon; Areg Grigorian

doi:10.1016/j.surg.2024.10.002

Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study

Surgery. 2024 Nov 8:S0039-6060(24)00884-5. doi: 10.1016/j.surg.2024.10.002. Online ahead of print.

Authors

Peter D Nguyen¹, Jeffry Nahmias¹, Negaar Aryan¹, Jason M Samuels², Michael Cripps³, Heather Carmichael³, Robert McIntyre Jr³, Shane Urban³, Clay Cothren Burlew³, Catherine Velopulos³, Shana Ballow⁴, Rachel C Dirks⁴, Marchall Chance Spalding⁵, Aimee LaRiccia⁶, Michael S Farrell⁷, Deborah M Stein⁸, Michael S Truitt⁹, Heather M Grossman Verner⁹, Caleb J Mentzer¹⁰, T J Mack¹⁰, Chad G Ball¹¹, Kaushik Mukherjee¹², Georgi Mladenov¹², Daniel J Haase¹³, Hossam Abdou¹³, Thomas J Schroeppel¹⁴, Jennifer Rodriquez¹⁴, Miklosh Bala¹⁵, Natasha Keric¹⁶, Morgan Crigger¹⁶, Navpreet K Dhillon¹⁷, Eric J Ley¹⁷, Tanya Egodage¹⁸, John Williamson¹⁸, Tatiana C P Cardenas¹⁹, Vadine Eugene¹⁹, Kumash Patel²⁰, Kristen Costello²⁰, Stephanie Bonne²¹, Fatima S Elgammal²², Warren Dorlac²³, Claire Pederson²³, Nicole L Werner²⁴, James M Haan²⁵, Kelly Lightwine²⁵, Gregory Semon²⁶, Kristen Spoor²⁷, Laura A Harmon²⁸, Areg Grigorian²⁹

Affiliations

¹ Division of Trauma, Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, CA.
² Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN.
³ Department of Surgery, University of Colorado, Aurora, CO.
⁴ Department of Surgery, UCSF-Fresno, CA.
⁵ Division of Trauma and Acute Care Surgery, Mount Carmel East, Columbus, OH.
⁶ Trauma, Critical Care and Acute Care Surgery, Grant Medical Center, Columbus, OH.
⁷ Department of Surgery, Lehigh Valley Health Network, Allentown, PA.
⁸ Departments of Emergency Medicine and Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
⁹ Graduate Medical Education, Methodist Dallas Medical Center, TX.
¹⁰ Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, Spartanburg Regional Medical Center, SC.
¹¹ Department of Surgery, University of Calgary, Alberta, Canada.
¹² Division of Acute Care Surgery, Loma Linda University Health, CA.
¹³ Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
¹⁴ Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO.
¹⁵ Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
¹⁶ Division of Trauma, Acute Care Surgery and Surgical Critical Care, Banner-University Medical Center Phoenix, AZ.
¹⁷ Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
¹⁸ Department of Surgery, Cooper University Hospital, Camden, NJ.
¹⁹ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, TZ.
²⁰ Division of Trauma Acute Care Surgery, Department of Surgery, Banner Thunderbird Medical Center, Glendale, AZ.
²¹ Division of Trauma and Surgical Critical Care, Department of Surgery, Hackensack University Medical Center, NJ.
²² Division of Trauma and Surgical Critical Care, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
²³ Department of Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, CO.
²⁴ University of Wisconsin-Madison School of Medicine and Public Health, WI.
²⁵ Department of Trauma, Ascension Via Christi Saint Francis, Wichita, KS.
²⁶ Department of Surgery, Miami Valley Hospital, Wright State University, Dayton, OH.
²⁷ Department of Surgery, Prisma Health-Upstate, Greenville, SC.
²⁸ Department of Surgery, Boulder Community Hospital, CO.
²⁹ Division of Trauma, Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, CA. Electronic address: [email protected].

PMID: 39521628
DOI: 10.1016/j.surg.2024.10.002

Abstract

Introduction: 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.

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.