Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment.

Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure.

Angiographic embolization (AE) has been used extensively for bleeding control after injuries to the face and neck. Its role in abdominal trauma requires further exploration. We reviewed the medical records of 137 consecutive patients who underwent angiography with the intent to embolize bleeding sites within the abdomen. Of them, 97 (71%) had blunt and 40 (29%) had penetrating trauma. AE was performed for hemorrhage associated with pelvic fractures (97 patients), liver lacerations (n = 26), renal lacerations (n = 12), splenic lacerations (n = 5), other injuries (n = 9), and multiple injuries (n = 12). On angiography, 102 patients were found to have bleeding sites and underwent AE, with angiographic and clinical bleeding control in 93 (91%). The rate of successful hemostasis by AE was identical in blunt and penetrating trauma patients. There was no major morbidity after AE. No factors predicted patients with a high likelihood to have a positive angiogram. Patients who had AE before or after a period of attempted hemodynamic stabilization in the intensive care unit were no different with respect to hemodynamic parameters immediately before AE or effectiveness of AE for bleeding control. AE is a safe and effective method for controlling bleeding after blunt and penetrating intra- and retroperitoneal injuries. Early AE may be used in selected patients as a front-line therapeutic intervention that offers expeditious hemostasis and prevents delays in definitive bleeding control.

Angiographic embolization for intraperitoneal and retroperitoneal injuries.

Partial splenic embolization.

Background: Hypersplenism secondary to portal hypertension is common in hepatocellular carcinoma (HCC), but surgeons still face the unresolved problem of how to manage HCC patients with hypersplenism. Study Design: The records of 48 patients with HCC and hypersplenism were retrospectively examined and postoperative changes in platelet counts, serum total bilirubin levels, and clinical staging scores were analyzed to evaluate the clinical value of combined splenectomy and liver resection. Hepatectomy and splenectomy were performed as a two-stage operation in 13 patients and synchronously in 35. Results: Postoperative platelet counts were significantly increased, and serum total bilirubin levels were significantly decreased. Clinical staging scores were also reduced after splenectomy in patients who underwent splenectomy before hepatectomy. Conclusions: Synchronous or metachronous splenectomy can increase the safety of hepatectomy in selected patients with HCC by reducing both the likelihood of bleeding complications and bilirubin overload.

https://www.journalacs.org/article/S1072-7515(99)00294-X/pdf

Splenectomy in patients with hepatocellular carcinoma and hypersplenism

Two cases are described in which therapeutic transcatheter Gelfoam embolization was complicated by fatal hepatic infarction in one patient and splenic infarction with abscess formation in another patient. These are unusual complications of this widely used therapeutic technique. The probable pathophysiology of these complications is discussed and suggestions for managing and avoiding them are made.

Terence J. Harrist

Papers

Hepatic and splenic infarctions: Complications of therapeutic transcatheter embolization