Relationship between Pseudoaneurysm Formation and Biloma after Successful Transarterial Embolization for Severe Hepatic Injury: Permanent Embolization Using Stainless Steel Coils Prevents Pseudoaneurysm Formation

摘要

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 >= III hepatic injury on contrast-enhanced computed tomographic scanning. When contrast extravasation was observed, transarterial embolization (TAE) was performed. After TAE, tech-netium-99m pyridoxyl-5-methyl-trypto-phan 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-ab-dominal 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.