Which artery is typically repaired in a deep liver laceration?

From the Guidelines

In a deep liver laceration, the hepatic artery is the primary vessel that requires repair, as evident from the 2020 WSES guidelines 1. When faced with significant liver trauma, immediate surgical intervention should focus on controlling hemorrhage from the hepatic arterial system, which is the main source of bleeding in deep parenchymal injuries. The surgical approach typically involves direct vessel ligation, selective embolization, or primary repair depending on the extent and location of the injury. Some key points to consider in the management of deep liver lacerations include:

• The importance of controlling hemorrhage and bile leak, and initiating damage control resuscitation as soon as possible 1.
• The use of angioembolization as a useful tool in case of persistent arterial bleeding after non-hemostatic or damage control procedures 1.
• The potential need for selective ligation of the hepatic artery or its branches, with consideration of cholecystectomy if the right or common hepatic artery must be ligated 1.
• The role of post-operative angioembolization as a viable alternative for hemorrhage control while reducing complications 1. The hepatic artery requires priority attention because it delivers oxygenated blood at high pressure to the liver, making arterial bleeding particularly dangerous and life-threatening. While portal vein and hepatic vein injuries may also occur, the hepatic artery's high-pressure system makes it the most critical vessel to address in the acute setting. Successful management requires rapid assessment, often with CT angiography if the patient is stable enough, followed by prompt surgical or interventional radiological approaches to control arterial hemorrhage.

From the Research

Artery Repair in Deep Liver Laceration

• The hepatic artery is a critical blood vessel that supplies oxygenated blood to the liver, and its injury can lead to severe complications, including liver necrosis and acute liver failure 2.
• In cases of deep liver laceration, the management of hepatic artery injury is crucial to prevent these complications.
• According to a study published in the Journal of Visceral Surgery, immediate restoration of arterial flow is indicated whenever technically feasible to prevent early life-threatening complications as well as late biliary stenosis 2.
• Another study published in the Annals of Surgery suggests that direct suture ligation of severed blood vessels and bile ducts is the most effective treatment for complex hepatic trauma, and hepatic artery ligation was not employed in any case 3.
• However, a study published in the British Journal of Surgery mentions that hepatic artery ligation has a limited but defined role in selected injuries 4.
• A study published in the Surgical Clinics of North America also mentions that selective hepatic artery ligation is one of the advanced techniques of repair for hepatic injuries 5.
• Additionally, a study published in Acta Radiologica found that ischemic liver injuries can develop in most patients undergoing hepatic artery embolization for postoperative arterial hemorrhage after hepatobiliary pancreatic surgery, and hepatic infarction appears to be the most frequent type of ischemic liver injury 6.

Key Considerations

• The management of hepatic artery injury in deep liver laceration requires immediate attention and restoration of arterial flow whenever possible.
• The choice of treatment depends on the severity of the injury and the patient's overall condition.
• A multidisciplinary approach, including a specialist team with expertise in managing postoperative complications, is essential for optimal outcomes 4.