Feasibility and efficacy of primary tractography during percutaneous catheter drainage

The indication of percutaneous catheter drainage (PCD) has expanded with the development of guiding modalities. Since serious complications still occur, efforts and new techniques have been continuously searched for safer PCD.

To evaluate the feasibility and efficacy of primary tractography for establishing a safe needle pathway during PCD.

A total of 42 patients (20 men, 22 women; mean age, 50.7 years) who underwent primary tractography during PCD were prospectively enrolled between April 2009 and August 2013. The locations of fluid collection included sub-phrenic (n = 8), between bowel loops (n = 21), pelvic cavity (n = 8), within solid organ (n = 2), and others (n = 3). The interposed anatomic structures were analyzed on the basis of primary tractography findings. Complications related to PCD or primary tractography were evaluated.

Interposition of any significant anatomic structure was confirmed in 10 of 42 patients (23.8%). The entrapped anatomic structures were the omental vessel (n = 4), bowel (n = 2), pleura (n = 2), bile duct (n = 2), and a branch of the left inferior epigastric artery (n = 1). In one patient, both the pleura and bile duct were interposed simultaneously. The technical and clinical success rates of PCD were 97.6% and 97.6%, respectively. No complications related to PCD or primary tractography occurred during the follow-up period.

Primary tractography is a simple and feasible method to evaluate the entrapment of normal anatomic structure during PCD. This method may aid in preventing possible serious PCD-related complications, such as bleeding and fistula.