What is the treatment procedure for liver embolism?

Hepatic Angioembolization for Liver Trauma

Angioembolization (AG/AE) should be considered as a first-line intervention in hemodynamically stable patients with arterial blush on CT scan, and is a critical tool for controlling persistent arterial bleeding after damage control procedures. 1

Initial Assessment and Patient Selection

The treatment approach depends entirely on hemodynamic status at presentation:

• Hemodynamically stable patients with arterial blush (contrast extravasation) on CT scan should undergo AG/AE as first-line therapy 1
• Hemodynamically unstable patients require immediate operative management; AG/AE serves as an adjunct for persistent arterial bleeding after surgical hemostasis or damage control procedures 1
• CT scan with intravenous contrast is mandatory before considering AG/AE to identify arterial injury 1

Indications for Angioembolization

Primary Indications (First-Line)

• Hemodynamically stable patients with arterial blush on CT imaging 1
• Delayed hemorrhage without severe hemodynamic compromise 1
• Hepatic artery pseudoaneurysm (to prevent rupture) 1

Secondary Indications (Adjunctive)

• Persistent arterial bleeding after non-hemostatic or damage control surgical procedures 1
• Post-operative bleeding following hepatic artery ligation or vascular repair 1
• Hemobilia from traumatic false aneurysm 2

Technical Procedure

The embolization procedure involves selective catheterization of the bleeding hepatic artery branch with directed embolic material to obliterate the bleeding source while preserving maximal hepatic perfusion. 3

• Immediate angiography should be performed once HAT or arterial injury is diagnosed 4
• Selective embolization of the specific bleeding vessel is preferred over proximal hepatic artery occlusion 3
• Success rate for hemorrhage control is approximately 83% 5

Critical Timing Considerations

Early angioembolization (performed immediately upon diagnosis) demonstrates superior outcomes compared to delayed intervention:

• Early AG/AE shows trends toward lower mortality (0% vs 50% for late intervention) 5
• Early AG/AE reduces packed red blood cell transfusion requirements 5
• Early AG/AE decreases the number of subsequent liver-related operations 5

Post-Embolization Management

Monitoring Requirements

• Serial clinical evaluations with physical exams and laboratory testing to detect status changes 1
• Monitor for complications including hepatic necrosis, biloma, and abscess formation (increased risk after arterial ligation) 1
• Watch for rebound thrombosis (occurs in approximately 28.6% of cases) 4

Complication Management

• Intrahepatic abscesses: percutaneous drainage 1
• Symptomatic or infected bilomas: percutaneous drainage 1
• Post-traumatic biliary complications: combination of percutaneous drainage and endoscopic techniques 1

Special Considerations

When AG/AE Should NOT Be First-Line

• Hemodynamically unstable patients require immediate operative management 1
• In hemodynamically stable children, contrast blush is not an absolute indication for AG/AE 1
• Patients with multiple organ injuries requiring surgery should undergo operative management 1

Adjunctive Measures

• If AG/AE fails or is unavailable, REBOA may be used as a bridge to definitive hemorrhage control in unstable patients 1
• Cholecystectomy should be performed if right or common hepatic artery ligation is required to prevent gallbladder necrosis 1

Anticoagulation Considerations

• For patients requiring anticoagulation (e.g., pulmonary embolism), antithrombotic therapy can be safely initiated approximately 72 hours after definitive surgical hemostasis 6
• LMWH-based prophylaxis should be started as soon as possible following trauma and may be safe in selected patients with liver injury treated non-operatively 1

Common Pitfalls to Avoid

• Do not delay AG/AE in stable patients with arterial blush—early intervention reduces transfusion requirements and subsequent operations 5
• Do not attempt AG/AE in unstable patients—these patients require immediate operative control 1
• Do not overlook post-embolization complications—hepatic necrosis, biloma, and abscess formation require vigilant monitoring 1
• Do not perform proximal hepatic artery ligation without considering post-operative AG/AE—this combination reduces complications while maintaining hemorrhage control 1