1. High-grade liver injuries with contrast extravasation managed initially with interventional radiology versus observation: A secondary analysis of a WTA multicenter study.
- Author
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Aryan N, Grigorian A, Tay-Lasso E, Cripps M, Carmichael H, McIntyre R Jr, Urban S, Velopulos C, Cothren Burlew C, Ballow S, Dirks RC, 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 TC, 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, Samuels JM, Spalding MC, and Nahmias J
- Subjects
- Humans, Female, Male, Middle Aged, Radiology, Interventional, Watchful Waiting, Retrospective Studies, Angiography, Aged, Adult, Contrast Media, Extravasation of Diagnostic and Therapeutic Materials, Liver injuries, Liver diagnostic imaging, Embolization, Therapeutic methods
- Abstract
Background: High-grade liver injuries with extravasation (HGLI + Extrav) are associated with morbidity/mortality. For low-grade injuries, an observation (OBS) first-strategy is beneficial over initial angiography (IR), however, it is unclear if OBS is safe for HGLI + Extrav. Therefore, we evaluated the management of HGLI + Extrav patients, hypothesizing IR patients will have decreased rates of operation and mortality., Methods: HGLI + Extrav patients managed with initial OBS or IR were included. The primary outcome was need for operation. Secondary outcomes included liver-related complications (LRCs) and mortality., Results: From 59 patients, 23 (39.0%) were managed with OBS and 36 (61.0%) with IR. 75% of IR patients underwent angioembolization, whereas 13% of OBS patients underwent any IR, all undergoing angioembolization. IR patients had an increased rate of operation (13.9% vs. 0%, p = 0.049), but no difference in LRCs (44.4% vs. 43.5%) or mortality (5.6% vs. 8.7%) versus OBS patients (both p > 0.05)., Conclusion: Over 60% of patients were managed with IR initially. IR patients had an increased rate of operation yet similar rates of LRCs and mortality, suggesting initial OBS reasonable in appropriately selected HGLI + Extrav patients., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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