Hepatic artery embolization for postoperative hemorrhage: importance of arterial collaterals and portal venous impairment

Abstract Purpose To investigate the association between hepatic ischemic complications and hepatic artery (HA) collaterals and portal venous (PV) impairment after hepatic artery (HA) embolization for postoperative hemorrhage. Materials and Methods Between October 2003 and November 2019, 42 patients underwent HA embolization for postoperative hemorrhage. HA collaterals were classified according to HA visualization after embolization (grade 1, none; grade 2, 1–4 segmental HA; grade 3, ≥4 segmental HA). Transhepatic portal vein stent placement was performed in the same session in 5 patients (11.9%) with poor HA collaterals (grade 1 or2) and compromised PV flow (>70% stenosis). Hepatic ischemic complications were analyzed for relevance to HA collaterals and PV compromise. Results After HA embolization, HA flow was preserved (grade 3) through intra- and/or extrahepatic collaterals in 23 patients (54.8%), and hepatic complications did not occur regardless of PV flow status (0%). Of the 19 patients with poor (grade 1 or 2) HA collaterals (45.2%), segmental hepatic infarction occurred in 2 out of 15 patients with preserved PV flow (10 naive and 5 stented) (13.3%). The remaining four patients with poor HA collaterals and untreated compromised PV flow experienced multi-segmental hepatic infarction (n=3) or hepatic failure (n=1) (100%) (p Conclusion After HA embolization, preserved HA flow (≥4 segmental HA) lowered the risk of hepatic complications regardless of the PV flow. Transhepatic PV stent placement seems to be an effective intervention for the prevention of hepatic complications in cases of poor HA collaterals and compromised PV flow.