Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study

Peter D. Nguyen; Jeffry Nahmias; Negaar Aryan; Jason M. Samuels; Michael Cripps; Heather Carmichael; Robert McIntyre; Shane Urban; Clay Cothren Burlew; Catherine Velopulos; Shana Ballow; Rachel C. Dirks; Marchall Chance Spalding; Aimee LaRiccia; Michael S. Farrell; Deborah M. Stein; Michael S. Truitt; Heather M. Grossman Verner; Caleb J. Mentzer; T. J. Mack; Chad G. Ball; Kaushik Mukherjee; Georgi Mladenov; Daniel J. Haase; Hossam Abdou; Thomas J. Schroeppel; Jennifer Rodriquez; Miklosh Bala; Natasha Keric; Morgan Crigger; Navpreet K. Dhillon; Eric J. Ley; Tanya Egodage; John Williamson; Tatiana C.P. Cardenas; Vadine Eugene; Kumash Patel; Kristen Costello; Stephanie Bonne; Fatima S. Elgammal; Warren Dorlac; Claire Pederson; Nicole L. Werner; James M. Haan; Kelly Lightwine; Gregory Semon; Kristen Spoor; Laura A. Harmon; Areg Grigorian

doi:10.1016/j.surg.2024.10.002

Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study

Peter D. Nguyen, Jeffry Nahmias, Negaar Aryan, Jason M. Samuels, Michael Cripps, Heather Carmichael, Robert McIntyre, Shane Urban, Clay Cothren Burlew, Catherine Velopulos, Shana Ballow, Rachel C. Dirks, Marchall Chance Spalding, Aimee LaRiccia, Michael S. Farrell, Deborah M. Stein, Michael S. Truitt, Heather M. Grossman Verner, Caleb J. Mentzer, T. J. MackChad G. Ball, Kaushik Mukherjee, Georgi Mladenov, Daniel J. Haase, Hossam Abdou, Thomas J. Schroeppel, Jennifer Rodriquez, Miklosh Bala, Natasha Keric, Morgan Crigger, Navpreet K. Dhillon, Eric J. Ley, Tanya Egodage, John Williamson, Tatiana C.P. Cardenas, Vadine Eugene, Kumash Patel, Kristen Costello, Stephanie Bonne, Fatima S. Elgammal, Warren Dorlac, Claire Pederson, Nicole L. Werner, James M. Haan, Kelly Lightwine, Gregory Semon, Kristen Spoor, Laura A. Harmon, Areg Grigorian

School of Medicine

Hackensack Meridian School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction: Hepatic angioembolization is highly effective for hemorrhage control in hemodynamically stable patients with traumatic liver injuries and contrast extravasation. However, there is a paucity of data regarding the specific location of angioembolization within the hepatic arterial vasculature and its implications on patient outcomes. Methods: A post-hoc analysis of a multicenter prospective observational study across 23 centers was performed. Adult patients undergoing main hepatic artery angioembolization or segmental hepatic artery angioembolization within 8 hours of arrival were included. The primary outcome was liver-related complications, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. Secondary outcomes were liver-related complication interventions, length of stay, and mortality. Results: A total of 55 patients underwent hepatic angioembolization, with 23 (41.8%) undergoing main hepatic artery angioembolization and 32 (58.2%) receiving segmental hepatic artery angioembolization. Both groups were comparable in age, vitals, mechanism of injury, liver injury grade distribution, and injury severity score (all P > .05). The main hepatic artery angioembolization group had greater rates of overall liver-related complications (65.2% vs 31.2%, P = .039), specifically perihepatic fluid collection (26.1% vs 6.3%, P = .040) and bile-leak/biloma (34.8% vs 12.5%, P = .048). Main hepatic artery angioembolization had greater rates of 2 or more liver-related complications (47.8% vs 9.4%, P = .001) and readmission within 30 days (30.4% vs 9.4%, P = .046). No significant differences were observed in hospital length of stay and mortality (all P > .05). Conclusions: Main hepatic artery angioembolization is associated with increased rates of liver-related complications, multiple liver-related complications, and readmission within 30 days compared with segmental hepatic artery angioembolization. Thus, main hepatic artery angioembolization should be reserved for use only when segmental hepatic artery angioembolization is not feasible, albeit with significantly increased morbidity.

Original language	English
Article number	108909
Journal	Surgery
Volume	178
DOIs	https://doi.org/10.1016/j.surg.2024.10.002
State	Published - Feb 2025

ASJC Scopus subject areas

Surgery

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10.1016/j.surg.2024.10.002

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Nguyen, P. D., Nahmias, J., Aryan, N., Samuels, J. M., Cripps, M., Carmichael, H., McIntyre, R., Urban, S., Burlew, C. C., Velopulos, C., Ballow, S., Dirks, R. C., Spalding, M. C., LaRiccia, A., Farrell, M. S., Stein, D. M., Truitt, M. S., Grossman Verner, H. M., Mentzer, C. J., ... Grigorian, A. (2025). Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study. Surgery, 178, Article 108909. https://doi.org/10.1016/j.surg.2024.10.002

@article{a7a86f64f6d84958b67aa252e243b93d,

title = "Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study",

abstract = "Introduction: Hepatic angioembolization is highly effective for hemorrhage control in hemodynamically stable patients with traumatic liver injuries and contrast extravasation. However, there is a paucity of data regarding the specific location of angioembolization within the hepatic arterial vasculature and its implications on patient outcomes. Methods: A post-hoc analysis of a multicenter prospective observational study across 23 centers was performed. Adult patients undergoing main hepatic artery angioembolization or segmental hepatic artery angioembolization within 8 hours of arrival were included. The primary outcome was liver-related complications, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. Secondary outcomes were liver-related complication interventions, length of stay, and mortality. Results: A total of 55 patients underwent hepatic angioembolization, with 23 (41.8%) undergoing main hepatic artery angioembolization and 32 (58.2%) receiving segmental hepatic artery angioembolization. Both groups were comparable in age, vitals, mechanism of injury, liver injury grade distribution, and injury severity score (all P > .05). The main hepatic artery angioembolization group had greater rates of overall liver-related complications (65.2% vs 31.2%, P = .039), specifically perihepatic fluid collection (26.1% vs 6.3%, P = .040) and bile-leak/biloma (34.8% vs 12.5%, P = .048). Main hepatic artery angioembolization had greater rates of 2 or more liver-related complications (47.8% vs 9.4%, P = .001) and readmission within 30 days (30.4% vs 9.4%, P = .046). No significant differences were observed in hospital length of stay and mortality (all P > .05). Conclusions: Main hepatic artery angioembolization is associated with increased rates of liver-related complications, multiple liver-related complications, and readmission within 30 days compared with segmental hepatic artery angioembolization. Thus, main hepatic artery angioembolization should be reserved for use only when segmental hepatic artery angioembolization is not feasible, albeit with significantly increased morbidity.",

author = "Nguyen, {Peter D.} and Jeffry Nahmias and Negaar Aryan and Samuels, {Jason M.} and Michael Cripps and Heather Carmichael and Robert McIntyre and Shane Urban and Burlew, {Clay Cothren} and Catherine Velopulos and Shana Ballow and Dirks, {Rachel C.} and Spalding, {Marchall Chance} and Aimee LaRiccia and Farrell, {Michael S.} and Stein, {Deborah M.} and Truitt, {Michael S.} and {Grossman Verner}, {Heather M.} and Mentzer, {Caleb J.} and Mack, {T. J.} and Ball, {Chad G.} and Kaushik Mukherjee and Georgi Mladenov and Haase, {Daniel J.} and Hossam Abdou and Schroeppel, {Thomas J.} and Jennifer Rodriquez and Miklosh Bala and Natasha Keric and Morgan Crigger and Dhillon, {Navpreet K.} and Ley, {Eric J.} and Tanya Egodage and John Williamson and Cardenas, {Tatiana C.P.} and Vadine Eugene and Kumash Patel and Kristen Costello and Stephanie Bonne and Elgammal, {Fatima S.} and Warren Dorlac and Claire Pederson and Werner, {Nicole L.} and Haan, {James M.} and Kelly Lightwine and Gregory Semon and Kristen Spoor and Harmon, {Laura A.} and Areg Grigorian",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2025",

month = feb,

doi = "10.1016/j.surg.2024.10.002",

language = "English",

volume = "178",

journal = "Surgery",

issn = "0039-6060",

publisher = "Elsevier Inc.",

}

Nguyen, PD, Nahmias, J, Aryan, N, Samuels, JM, Cripps, M, Carmichael, H, McIntyre, R, Urban, S, Burlew, CC, Velopulos, C, Ballow, S, Dirks, RC, Spalding, MC, LaRiccia, A, Farrell, MS, Stein, DM, Truitt, MS, Grossman Verner, HM, Mentzer, CJ, Mack, TJ, Ball, CG, Mukherjee, K, Mladenov, G, Haase, DJ, Abdou, H, Schroeppel, TJ, Rodriquez, J, Bala, M, Keric, N, Crigger, M, Dhillon, NK, Ley, EJ, Egodage, T, Williamson, J, Cardenas, TCP, Eugene, V, Patel, K, Costello, K, Bonne, S, Elgammal, FS, Dorlac, W, Pederson, C, Werner, NL, Haan, JM, Lightwine, K, Semon, G, Spoor, K, Harmon, LA & Grigorian, A 2025, 'Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study', Surgery, vol. 178, 108909. https://doi.org/10.1016/j.surg.2024.10.002

TY - JOUR

T1 - Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries

T2 - A Western Trauma Association multicenter study

AU - Nguyen, Peter D.

AU - Nahmias, Jeffry

AU - Aryan, Negaar

AU - Samuels, Jason M.

AU - Cripps, Michael

AU - Carmichael, Heather

AU - McIntyre, Robert

AU - Urban, Shane

AU - Burlew, Clay Cothren

AU - Velopulos, Catherine

AU - Ballow, Shana

AU - Dirks, Rachel C.

AU - Spalding, Marchall Chance

AU - LaRiccia, Aimee

AU - Farrell, Michael S.

AU - Stein, Deborah M.

AU - Truitt, Michael S.

AU - Grossman Verner, Heather M.

AU - Mentzer, Caleb J.

AU - Mack, T. J.

AU - Ball, Chad G.

AU - Mukherjee, Kaushik

AU - Mladenov, Georgi

AU - Haase, Daniel J.

AU - Abdou, Hossam

AU - Schroeppel, Thomas J.

AU - Rodriquez, Jennifer

AU - Bala, Miklosh

AU - Keric, Natasha

AU - Crigger, Morgan

AU - Dhillon, Navpreet K.

AU - Ley, Eric J.

AU - Egodage, Tanya

AU - Williamson, John

AU - Cardenas, Tatiana C.P.

AU - Eugene, Vadine

AU - Patel, Kumash

AU - Costello, Kristen

AU - Bonne, Stephanie

AU - Elgammal, Fatima S.

AU - Dorlac, Warren

AU - Pederson, Claire

AU - Werner, Nicole L.

AU - Haan, James M.

AU - Lightwine, Kelly

AU - Semon, Gregory

AU - Spoor, Kristen

AU - Harmon, Laura A.

AU - Grigorian, Areg

PY - 2025/2

Y1 - 2025/2

N2 - Introduction: Hepatic angioembolization is highly effective for hemorrhage control in hemodynamically stable patients with traumatic liver injuries and contrast extravasation. However, there is a paucity of data regarding the specific location of angioembolization within the hepatic arterial vasculature and its implications on patient outcomes. Methods: A post-hoc analysis of a multicenter prospective observational study across 23 centers was performed. Adult patients undergoing main hepatic artery angioembolization or segmental hepatic artery angioembolization within 8 hours of arrival were included. The primary outcome was liver-related complications, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. Secondary outcomes were liver-related complication interventions, length of stay, and mortality. Results: A total of 55 patients underwent hepatic angioembolization, with 23 (41.8%) undergoing main hepatic artery angioembolization and 32 (58.2%) receiving segmental hepatic artery angioembolization. Both groups were comparable in age, vitals, mechanism of injury, liver injury grade distribution, and injury severity score (all P > .05). The main hepatic artery angioembolization group had greater rates of overall liver-related complications (65.2% vs 31.2%, P = .039), specifically perihepatic fluid collection (26.1% vs 6.3%, P = .040) and bile-leak/biloma (34.8% vs 12.5%, P = .048). Main hepatic artery angioembolization had greater rates of 2 or more liver-related complications (47.8% vs 9.4%, P = .001) and readmission within 30 days (30.4% vs 9.4%, P = .046). No significant differences were observed in hospital length of stay and mortality (all P > .05). Conclusions: Main hepatic artery angioembolization is associated with increased rates of liver-related complications, multiple liver-related complications, and readmission within 30 days compared with segmental hepatic artery angioembolization. Thus, main hepatic artery angioembolization should be reserved for use only when segmental hepatic artery angioembolization is not feasible, albeit with significantly increased morbidity.

AB - Introduction: Hepatic angioembolization is highly effective for hemorrhage control in hemodynamically stable patients with traumatic liver injuries and contrast extravasation. However, there is a paucity of data regarding the specific location of angioembolization within the hepatic arterial vasculature and its implications on patient outcomes. Methods: A post-hoc analysis of a multicenter prospective observational study across 23 centers was performed. Adult patients undergoing main hepatic artery angioembolization or segmental hepatic artery angioembolization within 8 hours of arrival were included. The primary outcome was liver-related complications, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. Secondary outcomes were liver-related complication interventions, length of stay, and mortality. Results: A total of 55 patients underwent hepatic angioembolization, with 23 (41.8%) undergoing main hepatic artery angioembolization and 32 (58.2%) receiving segmental hepatic artery angioembolization. Both groups were comparable in age, vitals, mechanism of injury, liver injury grade distribution, and injury severity score (all P > .05). The main hepatic artery angioembolization group had greater rates of overall liver-related complications (65.2% vs 31.2%, P = .039), specifically perihepatic fluid collection (26.1% vs 6.3%, P = .040) and bile-leak/biloma (34.8% vs 12.5%, P = .048). Main hepatic artery angioembolization had greater rates of 2 or more liver-related complications (47.8% vs 9.4%, P = .001) and readmission within 30 days (30.4% vs 9.4%, P = .046). No significant differences were observed in hospital length of stay and mortality (all P > .05). Conclusions: Main hepatic artery angioembolization is associated with increased rates of liver-related complications, multiple liver-related complications, and readmission within 30 days compared with segmental hepatic artery angioembolization. Thus, main hepatic artery angioembolization should be reserved for use only when segmental hepatic artery angioembolization is not feasible, albeit with significantly increased morbidity.

UR - http://www.scopus.com/inward/record.url?scp=85208552304&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2024.10.002

DO - 10.1016/j.surg.2024.10.002

M3 - Article

C2 - 39521628

SN - 0039-6060

VL - 178

JO - Surgery

JF - Surgery

M1 - 108909

ER -

Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study

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