title: Prevention of significant hemobilia during placement of transhepatic biliary drainage catheters: technique modification and initial results.
abstract: OBJECTIVE
  The authors evaluated a technique for the prevention of significant hemobilia during placement of transhepatic biliary drainage catheters (TBDCs).
  
  
  METHODS
  Twenty patients with strictures were randomized to two groups. In the control group, the biliary tree was accessed with an Accustick system and a TBDC was placed routinely. In the experimental group, following initial access, a rotating hemostatic valve was attached and the outer sheath was pulled back over the wire while contrast material was injected. If a major vascular structure was encountered, the tract was not used for TBDC placement. However, the outer sheath was re-advanced and used to opacify the ducts. This facilitated separate access. Once access was achieved without traversing a major vascular structure, a TBDC was placed, and the Accustick system was removed. If a portal vein or hepatic vein branch was traversed, no additional maneuvers were performed. However, if a branch of the hepatic artery had been traversed, the tract and biliary-arterial fistula were embolized with gelatin sponge pledgets. Both groups were evaluated for hemobilia for 6 weeks.
  
  
  RESULTS
  In the control group, there were three cases of significant hemobilia; two were mild, one was severe. In the experimental group, the tract communicated with a major vascular structure in three patients. In these patients, a second access was used for TBDC placement. None of the patients in the experimental group experienced significant hemobilia.
  
  
  CONCLUSIONS
  Visualization prevents the usage of tracts that communicate with large vascular structures. Initial results indicate that this reduces the frequency of significant hemobilia when TBDCs are placed.
authors.affiliation: Department of Radiology, UCLA Medical Center 90024-1721, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Goodwin
authors.forename: B F
authors.initials: BF
authors.lastname: Stainken
authors.forename: T O
authors.initials: TO
authors.lastname: McNamara
authors.forename: H C
authors.initials: HC
authors.lastname: Yoon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D001658:Biliary Fistula / Q000209:etiology / Q000628:therapy; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D003287:Contrast Media; D004322:Drainage / Q000295:instrumentation; D004621:Embolization, Therapeutic; D005402:Fistula / Q000209:etiology / Q000628:therapy; D005500:Follow-Up Studies; D006431:Hemobilia / Q000209:etiology / Q000517:prevention & control*; D006499:Hepatic Artery / Q000293:injuries; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional; D014652:Vascular Diseases / Q000209:etiology / Q000628:therapy
chemical_list: D003287:Contrast Media