title: Catheter tract hemorrhage during percutaneous biliary intervention: management with use of a retained transhepatic guide wire.
abstract: OBJECTIVE
  The authors present their experience in managing freely flowing hemorrhage from immature catheter tracts in patients undergoing biliary drainage.
  
  
  METHODS
  Transhepatic guide wires were maintained securely whenever catheters were removed from the liver. Six patients among 71 hemorrhaged profusely when drains were manipulated within 4 days of initial catheterization. Management was attempted with use of the transhepatic guide wires.
  
  
  RESULTS
  Maneuvers performed over the retained guide wire controlled bleeding in all six patients. Reintubation constituted definitive therapy in five patients. A biliary-portal venous fistula in the remaining patient was treated with thrombin. The retained guide wire proved necessary in all cases.
  
  
  CONCLUSIONS
  Hemorrhage from immature catheter tracts can be managed, often definitively, with maneuvers performed over a retained transhepatic guide wire. Accordingly, a secure transhepatic guide wire is essential prior to removal of hepatic catheters and should remain in place until the absence of bleeding is established. These maneuvers may become increasingly important as courses of biliary catheterization become shorter.
authors.affiliation: Department of Radiology, University of California, San Francisco, USA.
authors.forename: E W
authors.initials: EW
authors.lastname: Olcott
authors.forename: R R
authors.initials: RR
authors.lastname: Saxon
authors.forename: E J
authors.initials: EJ
authors.lastname: Ring
authors.forename: R L
authors.initials: RL
authors.lastname: Gordon
mesh_terms: D000368:Aged; D001649:Bile Duct Diseases / Q000209:etiology; D001653:Bile Ducts, Intrahepatic / Q000293:injuries*; D001658:Biliary Fistula / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation*; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005402:Fistula / Q000209:etiology; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology*; D006489:Hemostatic Techniques; D006801:Humans; D008099:Liver; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology; D014652:Vascular Diseases / Q000209:etiology