Document Detail

Relationship between pseudoaneurysm formation and biloma after successful transarterial embolization for severe hepatic injury: permanent embolization using stainless steel coils prevents pseudoaneurysm formation.
MedLine Citation:
PMID:  16096538     Owner:  NLM     Status:  MEDLINE    
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.
Akiyoshi Hagiwara; Takehiko Tarui; Atsuo Murata; Takeaki Matsuda; Yoshihiro Yamaguti; Shuji Shimazaki
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  59     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-08-12     Completed Date:  2005-09-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  49-53; discussion 53-5     Citation Subset:  AIM; IM    
Department of Traumatology and Critical Care Medicine, Kyorin University, School of Medicine, Tokyo, Japan.
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MeSH Terms
Aged, 80 and over
Aneurysm, False / prevention & control*,  radiography,  radionuclide imaging
Bile Duct Diseases / prevention & control*,  radiography,  radionuclide imaging
Bile Ducts / injuries*
Child, Preschool
Contrast Media
Embolization, Therapeutic*
Extravasation of Diagnostic and Therapeutic Materials
Hepatic Artery / radiography,  radionuclide imaging
Injury Severity Score
Liver / injuries*
Middle Aged
Stainless Steel
Tomography, X-Ray Computed
Treatment Outcome
Wounds, Nonpenetrating / radiography,  radionuclide imaging,  therapy*
Reg. No./Substance:
0/Contrast Media; 12597-68-1/Stainless Steel

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