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Place of Arterial Embolization in Severe Blunt Hepatic Trauma: A Multidisciplinary Approach

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Abstract

This study evaluates the efficacy of arterial embolization (AE) for blunt hepatic traumas (BHT) as part of a combined management strategy based on the hemodynamic status of patients and CT findings. From 2000 to 2005, 84 patients were admitted to our hospital for BHT. Of these, 14 patients who had high-grade injuries (grade III [n = 2], grade IV [n = 9], grade V [n = 3]) underwent AE because of arterial bleeding and were included in the study. They were classified into three groups according to their hemodynamic status: (1) unresponsive shock, (2) shock improved with resuscitation, and (3) hemodynamic stability. Four patients (group 1) underwent, first, laparotomy with packing and, then, AE for persistent bleeding. Ten patients who were hemodynamically stable (group 1) or even unstable (group 2) underwent AE first, based on CT findings. AE was successful in all cases. The mortality rate was 7% (1/14). Only two angiography-related complications (gallbladder infarction) were reported. Liver-related complications (abdominal compartment syndrome and biliary complications) were frequent and often required secondary interventions. Our multidisciplinary approach for the management of BHT gives a main role to embolization, even for hemodynamically unstable patients. In this strategy AE is very efficient and has a low complication rate.

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Authors and Affiliations

  1. Department of Radiology, CHU A. Michallon, La Tronche, BP 217, Grenoble, 38043, France

    Valérie Monnin, Christian Sengel, Frédéric Thony, Ivan Bricault & Gilbert Ferretti

  2. Department of Digestive Surgery, CHU A. Michallon, Grenoble University 1, Grenoble, France

    David Voirin & Christian Letoublon

  3. Department of Anesthesia, CHU A. Michallon, Grenoble University 1, Grenoble, France

    Christophe Broux

Authors
  1. Valérie Monnin
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  2. Christian Sengel
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  3. Frédéric Thony
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  4. Ivan Bricault
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  5. David Voirin
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  6. Christian Letoublon
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  7. Christophe Broux
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  8. Gilbert Ferretti
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Correspondence to Valérie Monnin.

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Monnin, V., Sengel, C., Thony, F. et al. Place of Arterial Embolization in Severe Blunt Hepatic Trauma: A Multidisciplinary Approach. Cardiovasc Intervent Radiol 31, 875–882 (2008). https://doi.org/10.1007/s00270-007-9277-1

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  • DOI: https://doi.org/10.1007/s00270-007-9277-1

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