What role does arteriography play in the management of hepatic trauma?
Data support a grade III recommendation for the use of arteriography post-celiotomy or as an adjunct to nonoperative management. Arteriography with embolization was first used after initial operative management failed to control active bleeding (level V). It also had early use in extending the ability to nonoperatively manage patients with liver injury diagnosed by liver-spleen scan (level V). More recently, level III data have evaluated its use in the management of patients that required ongoing resuscitation to maintain normal hemodynamics. Although not always successful in avoiding the operating room, this technique appears to allow nonoperative management in a larger group of patients. It is important to realize that patients with previous embolization can bleed again (Hagiwara, 1993) and can suffer similar complications to those patients managed operatively (Carrillo, 1999). Further data are needed to make a stronger recommendation about whether initial operative management or ini
