Relationship between pseudoaneurysm formation and biloma after successful transarterial embolization for severe hepatic injury

Permanent embolization using stainless steel coils prevents pseudoaneurysm formation

Akiyoshi Hagiwara, Takehiko Tarui, Atsuo Murata, Takeaki Matsuda, Yoshihiro Yamaguti, Shuji Shimazaki, Donald Gaspard, Juan A. Asensio, David P. Blake

Research output: Contribution to journalArticle

22 Citations (Scopus)

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 ≥ 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.

Original languageEnglish
Pages (from-to)49-55
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume59
Issue number1
DOIs
StatePublished - Jul 2005

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False Aneurysm
Stainless Steel
Liver
Wounds and Injuries
Angiography
Porifera
Gelatin
Absorbable Gelatin Sponge
Injections
Technetium
Arteries

All Science Journal Classification (ASJC) codes

  • Surgery

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Relationship between pseudoaneurysm formation and biloma after successful transarterial embolization for severe hepatic injury : Permanent embolization using stainless steel coils prevents pseudoaneurysm formation. / Hagiwara, Akiyoshi; Tarui, Takehiko; Murata, Atsuo; Matsuda, Takeaki; Yamaguti, Yoshihiro; Shimazaki, Shuji; Gaspard, Donald; Asensio, Juan A.; Blake, David P.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 59, No. 1, 07.2005, p. 49-55.

Research output: Contribution to journalArticle

Hagiwara, Akiyoshi ; Tarui, Takehiko ; Murata, Atsuo ; Matsuda, Takeaki ; Yamaguti, Yoshihiro ; Shimazaki, Shuji ; Gaspard, Donald ; Asensio, Juan A. ; Blake, David P. / Relationship between pseudoaneurysm formation and biloma after successful transarterial embolization for severe hepatic injury : Permanent embolization using stainless steel coils prevents pseudoaneurysm formation. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 59, No. 1. pp. 49-55.
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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 ≥ 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.",
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T2 - Permanent embolization using stainless steel coils prevents pseudoaneurysm formation

AU - Hagiwara, Akiyoshi

AU - Tarui, Takehiko

AU - Murata, Atsuo

AU - Matsuda, Takeaki

AU - Yamaguti, Yoshihiro

AU - Shimazaki, Shuji

AU - Gaspard, Donald

AU - Asensio, Juan A.

AU - Blake, David P.

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N2 - 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 ≥ 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.

AB - 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 ≥ 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.

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