Relationship between pseudoaneurysm formation and biloma after successful transarterial embolization for severe hepatic injury: permanent embolization using stainless steel coils prevents pseudoaneurysm formation.

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 > or = 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.

• Authors: Akiyoshi Hagiwara, Takehiko Tarui, Atsuo Murata, Takeaki Matsuda, Yoshihiro Yamaguti, Shuji Shimazaki
• Journal: The Journal of trauma (J Trauma) Vol. 59 Issue 1 Pg. 49-53; discussion 53-5 (Jul 2005) ISSN: 0022-5282 [Print] United States
• PMID: 16096538 (Publication Type: Journal Article)

Chemical References

• Contrast Media
• Stainless Steel

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Aneurysm, False (diagnostic imaging, prevention & control)
• Angiography
• Bile Duct Diseases (diagnostic imaging, prevention & control)
• Bile Ducts (injuries)
• Child
• Child, Preschool
• Contrast Media
• Embolization, Therapeutic
• Extravasation of Diagnostic and Therapeutic Materials
• Female
• Hepatic Artery (diagnostic imaging)
• Humans
• Injury Severity Score
• Liver (injuries)
• Male
• Middle Aged
• Radionuclide Imaging
• Stainless Steel
• Tomography, X-Ray Computed
• Treatment Outcome
• Wounds, Nonpenetrating (diagnostic imaging, therapy)