Arteriographic Management of Hepatic Hemorrhage

To the Editor.—The recent report "Hepatic Artery Ligation for Delayed Hepatic Hemorrhage" (Archives 115:92, 1980) invites comment. The authors justly note that selective hepatic arterial ligation is an effective method for controlling acute and delayed hepatic hemorrhage and that it is usually well tolerated because of the excellent collateral vascular potential. Furthermore, they advocate preoperative arteriography to localize such bleeding and to identify hepatic arterial variations. Arteriography, however, may aid not only in the diagnostic evaluation but also in the treatment of these patients. Indeed, selective transcatheter hepatic arterial embolization can be an alternative in such cases, as has recently been demonstrated through the control of intrahepatic and intraperitoneal hepatic hemorrhage, as well as of hemobilia.^1,2 Embolization therapy has also proved useful in instances of aberrant hepatic vascular supply of the type that the authors encountered.¹

Considering the frequency of hepatic injury in abdominal trauma, the occasional limitations