title: Percutaneous transhepatic drainage of the nondilated biliary system.
abstract: OBJECTIVE
  The authors sought to develop a safe, efficacious technique for percutaneous transhepatic drainage of nondilated biliary systems.
  
  
  METHODS
  Twenty-three drainage procedures were performed on 14 consecutive patients with nondilated ducts. Fourteen procedures were carried out for primary placement of a transhepatic biliary drain, eight for placement of a second drain, and one for placement of a third drain. Drainage catheter access into the biliary tree was gained via direct puncture of a peripheral duct (fourth order or smaller branch) in four procedures. In the remaining 19 procedures, peripheral duct punctures were facilitated by retrograde passage of a 5-F catheter from a previous, remote percutaneous access site into the fourth-order duct to be punctured. Nine of these 19 duct punctures were facilitated by the use of a nitinol Goose Neck snare passed through the intraductal catheter.
  
  
  RESULTS
  Of the access methods used, the nitinol snare technique was the fastest. Successful peripheral access was achieved in all patients without bleeding complications. One patient developed symptoms of bacteremia, which resolved within 12 hours with antibiotic therapy and external biliary drainage.
  
  
  CONCLUSIONS
  Percutaneous peripheral access can be achieved safely in the nondilated biliary tree and can obviate surgery for some patients and facilitate future interventions.
authors.affiliation: Department of Radiology, Indiana University Hospital, Indianapolis 46202-5253.
authors.forename: V J
authors.initials: VJ
authors.lastname: Harris
authors.forename: K K
authors.initials: KK
authors.lastname: Kopecky
authors.forename: J T
authors.initials: JT
authors.lastname: Harman
authors.forename: D W
authors.initials: DW
authors.lastname: Crist
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries; D002404:Catheterization / Q000379:methods; D002758:Cholangiography; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011677:Punctures; D015641:Radiography, Interventional