Vascular complications in percutaneous biliary interventions

Percutaneous biliary interventions are indicated for both benign or malignant biliary strictures to treat obstructive jaundice and/or biliary leak. Major vascular complications include active bleeding or more frequently pseudoaneurysm formation, bilio-portal, bilio-venous or arterio-biliary fistulae and intra- or peri-hepatic hematoma. Such adverse events can occur during the procedure itself or, more often, several days to weeks after the initial procedure. Major vascular complications frequently manifest with symptoms of hemobilia (jaundice, pain, melena or hemochezia and reduced serum hemoglobin levels), which in some cases lead to life-threatening hemodynamic compromise. Computed tomography angiography is mandatory to diagnose the cause and site of bleeding, while simultaneously depicting the anatomy, in order to plan the treatment. Covered stents, liquid embolic agents and coils are the commonest devices used, depending on the underlying pathology. Although such complications are rare, they are frequently life-threatening, and require prompt treatment. Therefore, interventional radiologists must be proficient in their management. This narrative minireview aims to outline management strategies of the most frequent intra- or post-procedural vascular complications following biliary interventions.