title: Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients.
abstract: OBJECTIVE
  To retrospectively determine if patients with a history of intraoperative bile duct injury or liver transplantation have an increased risk for arterial injury (AI) during percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD) compared with the risk of AI established in the 1970s and 1980s.
  
  
  METHODS
  This study was approved by the committee on human research and was deemed compliant with the Health Insurance Portability and Accountability Act. The informed consent requirement was waived. Records of 1394 procedures (307 PTCs, 1087 PTBDs) performed in 930 patients (445 male, 485 female; age range, 4 months to 99 years) over the past 13 years were retrospectively reviewed. The rate of AI was determined, and demographic, pathologic, technical, and laboratory variables were tested for association with increased risk of AI by using generalized estimating equation analysis.
  
  
  RESULTS
  AIs were encountered after 30 (2.2%) biliary procedures. No significant difference in the rate of AI was seen among the groups of patients with malignant biliary obstruction (1.8%), history of bile duct injury (2.2%), or complications of liver transplantation (2.6%). Patients who underwent PTBD had a higher risk of AI than did patients who underwent PTC (2.6% vs 0.7%); however, this difference was not significant (P = .06). Ongoing hemobilia was seen in 26 (87%) of the patients, which made it the most common sign of AI, and it had a 94% positive predictive value for AI. A postprocedure decrease in the hematocrit level of more than 13% was seen only in the setting of AI, and it occurred in only three (10%) of patients with AIs.
  
  
  CONCLUSIONS
  PTC and PTBD performed for management of bile duct injury and complications of liver transplantation are not associated with an increased risk of hepatic AIs compared with the risk of AI reported in the 1970s and 1980s.
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, Room M-361, San Francisco, CA 94143, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
authors.forename: Allan I
authors.initials: AI
authors.lastname: Bloom
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Laberge
authors.forename: Mark W
authors.initials: MW
authors.lastname: Wilson
authors.forename: Ernest J
authors.initials: EJ
authors.lastname: Ring
authors.forename: Roy L
authors.initials: RL
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003287:Contrast Media; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003287:Contrast Media