Tube tamponade: potential pitfall in angiography of arterial hemorrhage associated with percutaneous drainage catheters
Related Experiment Videos
W D Routh1, C M Tatum, R B Lawdahl
1Department of Diagnostic Radiology, University of Alabama, School of Medicine, Birmingham 35233.
Insights
Removing drainage catheters can reveal severe hemorrhage during diagnostic angiography. Repeat angiography after catheter removal for accurate bleeding site localization and effective embolotherapy.
Area of Science:
- Interventional Radiology
- Vascular Imaging
- Hemorrhage Management
Background:
- Diagnostic angiography is crucial for identifying bleeding sources in patients with percutaneous drains.
- Percutaneous transhepatic biliary and nephrostomy catheters are common interventions that can lead to complications.
- Initial angiography may be unrewarding with drainage catheters in situ due to tamponade effect.
Observation:
- In patients with percutaneous biliary or nephrostomy catheters, diagnostic angiography performed with the catheter in place failed to identify hemorrhage sources.
- Removal of the drainage catheter in these patients led to severe, pulsatile hemorrhage from the tract.
- This hemorrhage allowed for successful angiographic localization of the bleeding site.
Findings:
- Immediate repeat angiography after drainage catheter removal successfully identified bleeding sites in all cases.
- Temporary hemorrhage control was achieved using angioplasty balloons within the tract.
- Transcatheter embolotherapy provided definitive bleeding control in most patients.
Implications:
- Angiography for hemorrhage in patients with percutaneous drains should be repeated immediately after catheter removal if initial studies are negative.
- Drainage catheters should be removed over a guidewire to allow rapid reinsertion of a tamponading catheter if severe hemorrhage occurs.
- This approach ensures prompt hemorrhage control until definitive treatment can be performed.
Abstract:
Diagnostic angiography performed to search for a source of hemorrhage in three patients with percutaneous transhepatic biliary catheters and one patient with a percutaneous nephrostomy catheter was initially unrewarding when performed with the drainage catheter in place. In each patient, removal of the drainage catheter resulted in severe pulsatile hemorrhage from the parenchymal tract and allowed angiographic localization of the bleeding site. Temporary control of the hemorrhage was then obtained by inflating an angioplasty balloon within the tract. Transcatheter embolotherapy provided definitive control of bleeding in three patients. When initial angiographic evaluation for bleeding in patients with percutaneous biliary and nephrostomy catheters fails to depict a source, the study should be repeated immediately after removal of the drainage catheter. Because hemorrhage can be severe once tamponade is relieved, the drainage catheter should be withdrawn over a guide wire so that a tamponading catheter can be rapidly reinserted to control hemorrhage until more definitive therapy is undertaken.