High-grade liver injuries with contrast extravasation managed initially with interventional radiology versus observation: A secondary analysis of a WTA multicenter study

Authors

• Negaar Aryan, University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, USA. Electronic address: negaara@hs.uci.edu.
• Areg Grigorian, University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, USA. Electronic address: agrigori@hs.uci.edu.
• Erika Tay-Lasso, University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, USA. Electronic address: erikataymd@gmail.com.
• Michael Cripps, UCH Hospital Anschutz Medical Campus, USA. Electronic address: michael.cripps@cuanschutz.edu.
• Heather Carmichael, UCH Hospital Anschutz Medical Campus, USA. Electronic address: heather.carmichael@cuanschutz.edu.
• Robert McIntyre, UCH Hospital Anschutz Medical Campus, USA. Electronic address: robert.mcintyre@cuanschutz.edu.
• Shane Urban, UCH Hospital Anschutz Medical Campus, USA. Electronic address: shane.urban@uchealth.org.
• Catherine Velopulos, UCH Hospital Anschutz Medical Campus, USA. Electronic address: catherine.velopulos@cuanschutz.edu.
• Clay Cothren Burlew, UCH Hospital Anschutz Medical Campus, USA. Electronic address: clay.burlew@cuanschutz.edu.
• Shana Ballow, University of California, San Francisco-Fresno, USA. Electronic address: shana.ballow@ucsf.edu.
• Rachel C. Dirks, University of California, San Francisco-Fresno, USA. Electronic address: Rachel.c.dirks@gmail.com.
• Aimee LaRiccia, Grant Medical Center, USA. Electronic address: aimee.lariccia@gmail.com.
• Michael S. Farrell, Lehigh Valley Health Network, Allentown, PA, USA. Electronic address: mfarrellmd@gmail.com.
• Deborah M. Stein, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, USA. Electronic address: dstein@som.umaryland.edu.
• Michael S. Truitt, Methodist Dallas Medical Center, USA. Electronic address: michaeltruitt@mhd.com.
• Heather M. Grossman Verner, Methodist Dallas Medical Center, USA. Electronic address: heathergrossmanverner@mhd.com.
• Caleb J. Mentzer, Spartanburg Regional Medical Center, USA. Electronic address: cmentzer@srhs.com.
• T J. Mack, Spartanburg Regional Medical Center, USA. Electronic address: tmack@srhs.com.
• Chad G. Ball, University of Calgary, Canada. Electronic address: ball.chad@gmail.com.
• Kaushik Mukherjee, Division of Acute Care Surgery, Loma Linda University Health, USA. Electronic address: kmukherjee@llu.edu.
• Georgi Mladenov, Division of Acute Care Surgery, Loma Linda University Health, USA. Electronic address: gmladenov@llu.edu.
• Daniel J. Haase, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Department of Emergency Medicine and Surgery, USA. Electronic address: dhaase@som.umaryland.edu.
• Hossam Abdou, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Department of Emergency Medicine and Surgery, USA. Electronic address: habdou@som.umaryland.edu.
• Thomas J. Schroeppel, UCHealth Memorial Hospital, USA. Electronic address: thomas.schroeppel@uchealth.org.
• Jennifer Rodriquez, UCHealth Memorial Hospital, USA. Electronic address: jennifer.rodriquez4@uchealth.org.
• Miklosh Bala, Hadassah Medical Center, USA. Electronic address: rbalam@hadassah.org.il.
• Natasha Keric, Banner-University Medical Center Phoenix, USA. Electronic address: natasha.keric@bannerhealth.com.
• Morgan Crigger, Banner-University Medical Center Phoenix, USA. Electronic address: mcrigger1@gmail.com.
• Navpreet K. Dhillon, Cedars-Sinai Medical Center, USA. Electronic address: navpreet.dhillon@umm.edu.
• Eric J. Ley, Cedars-Sinai Medical Center, USA. Electronic address: eric.ley@cshs.org.
• et al

Recommended Citation

Aryan N, Grigorian A, Tay-Lasso E, et al. High-grade liver injuries with contrast extravasation managed initially with interventional radiology versus observation: A secondary analysis of a WTA multicenter study. Am J Surg. Aug 2024;234:105-111. doi:10.1016/j.amjsurg.2024.03.018

Affiliations

Advocate Christ Medical Center

Abstract

BACKGROUND: High-grade liver injuries with extravasation (HGLI ​+ ​Extrav) are associated with morbidity/mortality. For low-grade injuries, an observation (OBS) first-strategy is beneficial over initial angiography (IR), however, it is unclear if OBS is safe for HGLI ​+ ​Extrav. Therefore, we evaluated the management of HGLI ​+ ​Extrav patients, hypothesizing IR patients will have decreased rates of operation and mortality. METHODS: HGLI ​+ ​Extrav patients managed with initial OBS or IR were included. The primary outcome was need for operation. Secondary outcomes included liver-related complications (LRCs) and mortality. RESULTS: From 59 patients, 23 (39.0%) were managed with OBS and 36 (61.0%) with IR. 75% of IR patients underwent angioembolization, whereas 13% of OBS patients underwent any IR, all undergoing angioembolization. IR patients had an increased rate of operation (13.9% vs. 0%, p ​= ​0.049), but no difference in LRCs (44.4% vs. 43.5%) or mortality (5.6% vs. 8.7%) versus OBS patients (both p ​> ​0.05). CONCLUSION: Over 60% of patients were managed with IR initially. IR patients had an increased rate of operation yet similar rates of LRCs and mortality, suggesting initial OBS reasonable in appropriately selected HGLI ​+ ​Extrav patients.

Type

Article

PubMed ID

38553335