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 language | English |
|---|---|
| Pages (from-to) | 49-55 |
| Number of pages | 7 |
| Journal | Journal of Trauma - Injury, Infection and Critical Care |
| Volume | 59 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 2005 |
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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 journal › Article
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TY - JOUR
T1 - Relationship between pseudoaneurysm formation and biloma after successful transarterial embolization for severe hepatic injury
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.
PY - 2005/7
Y1 - 2005/7
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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U2 - 10.1097/01.TA.0000171457.18637.69
DO - 10.1097/01.TA.0000171457.18637.69
M3 - Article
VL - 59
SP - 49
EP - 55
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 1
ER -