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Arterial complications of percutaneous transhepatic biliary drainage
C L'Hermine1, O Ernst, O Delemazure
1Department of Radiology, Hospital Claude Huriez, Place de Verdun, F-59037 Lille Cedex, France.
Insights
Arterial complications from percutaneous transhepatic biliary drainage (PTBD) are rare but treatable. Arterial embolization effectively manages bleeding, especially in cases of benign biliary stenosis.
Area of Science:
- Interventional Radiology
- Vascular Surgery
Background:
- Percutaneous transhepatic biliary drainage (PTBD) is a common procedure for biliary obstruction.
- Arterial complications, though infrequent, can occur during PTBD.
Purpose of the Study:
- To determine the incidence of arterial complications following PTBD.
- To evaluate treatment strategies for these complications.
Main Methods:
- A retrospective review of 525 patients undergoing PTBD.
- Analysis of intrahepatic artery lesions, including hemobilia and subcapsular hematoma.
- Correlation of complications with the type of biliary stenosis (benign vs. malignant).
Main Results:
- Arterial lesions occurred in 2% of patients (10/525).
- Hemobilia was the most common complication (9 patients).
- Arterial embolization was successful in 7 out of 10 patients requiring intervention.
Conclusions:
- Arterial bleeding is a rare but manageable complication of PTBD.
- Selective arterial embolization is an effective treatment.
- The frequency of arterial complications was significantly higher in benign biliary stenosis (16%) compared to malignant stenosis (0.6%).
Purpose:
To report on the frequency and treatment of arterial complications due to percutaneous transhepatic biliary drainage (PTBD).
Materials:
Lesions of the intrahepatic artery were encountered in 10 of 525 patients treated by PTBD (2%). Hemobilia followed in 9 patients and subcapsular hematoma in 1. Seven patients had a benign biliary stenosis and 3 had a malignant stenosis.
Results:
The bleeding resolved spontaneously in 3 patients. In 7 it required arterial embolization, which was successfully achieved either through the percutaneous catheter (n = 3) or by arteriography (n = 4).
Conclusion:
Arterial bleeding is a relatively rare complication of PTBD that can easily be treated by selective arterial embolization when it does not resolve spontaneously. In this series its frequency was much higher (16%) when the stenosis was benign than when it was malignant (0.6%).