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The need for early angiographic embolization in blunt liver injuries.
Wahl, Wendy L; Ahrns, Karla S; Brandt, Mary-Margaret; Franklin, Glen A; Taheri, Paul A.
Afiliação
  • Wahl WL; Division of Trauma Burn and Emergency Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0033, USA. wlwahl@med.umich.edu
J Trauma ; 52(6): 1097-101, 2002 Jun.
Article em En | MEDLINE | ID: mdl-12045636
ABSTRACT

BACKGROUND:

Although nonoperative management of blunt liver injury (BLI) has become standard practice, adjuncts to nonoperative therapy, such as angiographic embolization, have not been well characterized.

METHODS:

Patients with BLI were retrospectively identified at our American College of Surgeons-verified Level I trauma center from January 1997 through February 2001. Patients were stratified into four groups those who received angiographic embolization (AE) as an early intervention when BLI was initially diagnosed (EARLY-AE); those who underwent AE after liver-related operation or later in the hospital course (LATE-AE); those treated with operation only (OR-ONLY); and nonoperative patients who also did not undergo AE (NO-OR).

RESULTS:

There were 126 patients with BLI, of whom 94 were NO-OR, 20 were OR-ONLY, 6 had LATE-AE, and 6 had EARLY-AE. The NO-OR group had significantly lower liver Abbreviated Injury Scale scores. Liver Abbreviated Injury Scale scores were not different between the EARLY-AE, LATE-AE, and OR-ONLY groups. Liver-related mortality was not lower for those treated with AE. There was a trend toward lower mortality for just the EARLY-AE group compared with the LATE-AE and OR-ONLY groups (0% vs. 50% and 35%). The number of units of packed red blood cells transfused and the number of liver-related operations were lower in the EARLY-AE compared with the LATE-AE group, but liver-related complications were not different between the EARLY-AE, LATE-AE, or OR-ONLY groups. AE was successful in arresting hemorrhage in 83% of the cases.

CONCLUSION:

In this small series, we observed similar morbidity and mortality with AE compared with operative therapy. EARLY-AE did decrease blood use and the number of liver-related operations. AE can be performed on severely injured patients with comparable liver-related mortality and complications. Further study of the timing of and outcomes from AE is needed.
Assuntos
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Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Ano de publicação: 2002 Tipo de documento: Article
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Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Ano de publicação: 2002 Tipo de documento: Article