Predictive factors for early failure of transarterial embolization in blunt hepatic injury patients

• Published in: Clinical radiology Vol. 69; no. 12; pp. e505 - e511
• Main Authors: Lee, Y.-H, Wu, C.-H, Wang, L.-J, Wong, Y.-C, Chen, H.-W, Wang, C.-J, Lin, B.-C, Hsu, Y.-P
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2014
• Subjects: Adolescent; Adult; Child; Contrast Media; Embolization, Therapeutic - methods; Extravasation of Diagnostic and Therapeutic Materials - diagnostic imaging; Female; Heart Rate - physiology; Hemorrhage - diagnostic imaging; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Liver - diagnostic imaging; Liver - injuries; Male; Middle Aged; Radiographic Image Enhancement - methods; Radiology; Retreatment - methods; Retreatment - statistics & numerical data; Retrospective Studies; Severity of Illness Index; Tomography, X-Ray Computed - methods; Treatment Failure; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - therapy; Young Adult
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2014.08.013

Aim To evaluate the early success of transarterial embolization (TAE) in patients with traumatic liver haemorrhage and to determine independent factors for its failure. Materials and methods From January 2009 to December 2012, TAE was performed in 48 patients for traumatic liver haemorrhage. Their medical charts were reviewed for demographic information, pre-TAE vital signs and laboratory data, injury grade, type of contrast medium extravasation (CME) at CT, angiography findings, and early failure. “Early failure” was defined as the need for repeated TAE or a laparotomy for hepatic haemorrhage within 4 days after TAE. Variables were compared between the early success and early failure groups. Variables with univariate significance were also analysed using multivariate logistic regression for predictors of early failure. Results Among 48 liver TAE cases, nine (18.8%) were early failures due to liver haemorrhage. Early failure was associated with injury grade ( p  = 0.039), major liver injury (grades 4 and 5; p  = 0.007), multiple CMEs at angiography ( p  = 0.031), incomplete TAE ( p  = 0.002), and elevated heart rate ( p  = 0.026). Incomplete embolization (OR = 8; p  = 0.042), and heart rate >110 beats/min (bpm; OR = 8; p  = 0.05) were independent factors for early failure of TAE in the group with major liver injuries. Conclusion Major hepatic injury is an important factor in early failure. Patients with a heart rate >110 bpm and incomplete embolization in the major injury group have an increased rate of early failure. The success rate of proximal TAE was comparable to that of the more time-consuming, superselective, distal TAE.