Management of severe liver injury continues to evolve. The rate of hemorrhage control laparotomy has decreased significantly over the decades, with a corresponding increase in the use of liver angioembolization (LAE).1 In this study, the authors have performed an interesting analysis of the outcomes and complications that occur postangioembolization.2 While it’s been recognized that there is no consensus on which patients will benefit most from LAE, it remains a valuable tool trauma surgeons can use and is recommended by major trauma society guidelines.3 4
Perhaps the most helpful information from this work is a detailed analysis of the natural course and description of the expectant management postembolization. This may be especially helpful for the practicing trauma surgeon as a starting point to counsel and guide patients and families on what to expect next. Patients feel reassured when they are told they don’t need ‘surgery’ and that ‘we can stop the bleeding with a catheter’. We tell them it’s well tolerated, and rarely do patients go on to ‘need an operation’. While that appears to be true, we may be unintentionally misleading them, leading to unrealistic and unmet expectations for the rest of their recovery. The reality is these are high-grade and serious injuries, and while we can non-operatively manage many of them, around 1 in 10 will need additional intervention to treat complications from their injury. The authors show that even without an open operation, these patients will still require prolonged hospital stays and additional time in the intensive care unit. Perhaps most striking is the time interval to liver drainage interventions, which averages more than 2 weeks after injury. While many patients will still be admitted, these data highlight the importance of counseling patients before discharge; they aren’t entirely clear and need to come back at the first sign of trouble.
LAE plays an important role in the non-operative management of severe hepatic trauma. Studies like this one are essential for our understanding of embolization outcomes. Hopefully, as we continue to develop additional data and reach a consensus on which patients to embolize, we can develop strategies to minimize the complications as well.
Footnotes
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Patient consent for publication: Not applicable.
Ethics approval: Not applicable.
Provenance and peer review: Commissioned; internally peer reviewed.
References
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