Hepatic infarction following selective hepatic artery embolization with microcoils for iatrogenic biliary hemorrhage.
Purpose: The aim of this study was to explore the relation of collateral filling to ischemic or infarcted liver following selective embolization of hepatic artery with microcoils in patients with iatrogenic hemobilia. Methods: We performed retrospective analysis of clinical outcomes and post-embolization angiograms in eight patients (mean age of 66 years) studied over the last 7 years. Hemobilia occurred after percutaneous biliary drainage (n = 5) and percutaneous hepatic biopsy (n = 3). Causes of bleeding were pseudoaneurysm (n = 6), arterial laceration (n = 1), and direct hepatic artery-to-biliary duct fistula (n = 1). We placed microcoils in the subsegmental (n = 4) or segmental branch (n = 2), or both branches (n = 2), distal and proximal to the bleeding point. Results: We obtained complete hemostasis in all patients (100%). Four patients had no hepatic infarction after embolization. Normal filling of the distal part of the embolized branch through collaterals was seen on post-embolization films. Four patients with no collateral filling experienced liver infarction in the area corresponding to embolized branch. One patient with severe portal stenosis died of hepatic failure. Conclusion: Hepatic infarction is related to lack of immediate collateral flow.
Hashimoto
Manabu
M
Department of Radiology, Akita University School of Medicine, Hondo 1-1-1, Akita City, Akita 010-8543, Japan.
Akabane
Yoko
Y
Heianna
Jyouichi
J
Tate
Etuko
E
Ishiyama
Koichi
K
Nishii
Toshiaki
T
Watarai
Jiro
J