Endovascular Management of Hepatic Lacerations

Abstract

Given the high propensity of the liver to sustain lacerations during abdominal trauma, it is important for the interventional radiologist to recognize associated vascular injuries and develop an appropriate endovascular approach. This is especially important given recent changes in trauma practice, as transcatheter embolization has become an established component of the management of hepatic lacerations. This review of hepatic lacerations will provide a ready summary of transarterial management of hepatic lacerations and their complications.

Keywords

hepatic laceration - transcatheter - embolization - arterioportal - fistula

Publication History

Received: 07 December 2024

Accepted: 06 March 2025

Article published online:
03 April 2025

• References

• 1 Cirocchi R, Trastulli S, Pressi E. et al. Non-operative management versus operative management in high-grade blunt hepatic injury. (Review) Cochrane Database Syst Rev 2015; 2015 (08) CD010989
• 2 Noorbakhsh S, Gomez L, Joung Y. et al. Hepatic arterioportal fistula following liver trauma: case series and review of the literature. Vasc Endovascular Surg 2023; 57 (07) 749-755
• 3 Taourel P, Vernhet H, Suau A, Granier C, Lopez FM, Aufort S. Vascular emergencies in liver trauma. Eur J Radiol 2007; 64 (01) 73-82
• 4 Kozar RA, Crandall M, Shanmuganathan K. et al; AAST Patient Assessment Committee. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg 2018; 85 (06) 1119-1122
• 5 Coccolini F, Coimbra R, Ordonez C. et al; WSES Expert Panel. Liver trauma: WSES 2020 guidelines. World J Emerg Surg 2020; 15 (01) 24
• 6 Gilyard S, Shinn K, Nezami N. et al. Contemporary management of hepatic trauma: what IRs need to know. Semin Intervent Radiol 2020; 37 (01) 35-43
• 7 Hurtuk M, Reed II RL, Esposito TJ, Davis KA, Luchette FA. Trauma surgeons practice what they preach: the NTDB story on solid organ injury management. J Trauma 2006; 61 (02) 243-254 , discussion 254–255
• 8 Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg 2016; 80 (03) 529-537
• 9 Salimi J, Bakhtavar K, Solimani M, Khashayar P, Meysamie AP, Zargar M. Diagnostic accuracy of CT scan in abdominal blunt trauma. Chin J Traumatol 2009; 12 (02) 67-70
• 10 Romano L, Giovine S, Guidi G, Tortora G, Cinque T, Romano S. Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging. Eur J Radiol 2004; 50 (01) 59-66
• 11 Shuman WP. CT of blunt abdominal trauma in adults. Radiology 1997; 205 (02) 297-306
• 12 Ordoñez CA, Parra MW, Millán M. et al. Damage control in penetrating liver trauma: fear of the unknown. Colomb Med (Cali) 2020; 51 (04) e4134365
• 13 Roberts R, Sheth RA. Hepatic trauma. Ann Transl Med 2021; 9 (14) 1195-1195
• 14 Pillai AS, Kumar G, Pillai AK. Hepatic trauma interventions. Semin Intervent Radiol 2021; 38 (01) 96-104
• 15 Lamb CM, Garner JP. Selective non-operative management of civilian gunshot wounds to the abdomen: a systematic review of the evidence. Injury 2014; 45 (04) 659-666
• 16 Padia SA, Ingraham CR, Moriarty JM. et al. Society of Interventional Radiology Position Statement on endovascular intervention for trauma. J Vasc Interv Radiol 2020; 31 (03) 363-369.e2
• 17 Lopera JE. Embolization in trauma: review of basic principles and techniques. Semin Intervent Radiol 2021; 38 (01) 18-33
• 18 Deville PE, Marr AB, Cone JT. et al; MIT Liver Study Group. Multicenter study of perioperative hepatic angioembolization as an adjunct for management of major operative hepatic trauma. J Am Coll Surg 2023; 237 (05) 697-703
• 19 Kumar A, Ahuja CK, Vyas S. et al. Hepatic arteriovenous fistulae: role of interventional radiology. Dig Dis Sci 2012; 57 (10) 2703-2712
• 20 Segalini E, Morello A, Leati G, Di Saverio S, Aseni P. Primary angioembolization in liver trauma: major hepatic necrosis as a severe complication of a minimally invasive treatment - a narrative review. Updates Surg 2022; 74 (05) 1511-1519
• 21 Hsu CP, Wang SY, Hsu YP. et al. Risk factors for liver abscess formation in patients with blunt hepatic injury after non-operative management. Eur J Trauma Emerg Surg 2014; 40 (05) 547-552