title: Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile?
abstract: OBJECTIVE
  PTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique.
  
  
  METHODS
  Haemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010 and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan-Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test.
  
  
  RESULTS
  Haemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC.
  
  
  CONCLUSIONS
  Introduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract.
authors.affiliation: Department of Medical Microbiology, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK. adamdale@doctors.org.uk.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Dale
authors.affiliation: Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. rafeh.khan@yahoo.com.
authors.forename: Rafeh
authors.initials: R
authors.lastname: Khan
authors.affiliation: Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. anup.mathew@sth.nhs.uk.
authors.forename: Anup
authors.initials: A
authors.lastname: Mathew
authors.affiliation: Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. Naomi.Hersey@sth.nhs.uk.
authors.forename: Naomi O
authors.initials: NO
authors.lastname: Hersey
authors.affiliation: Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. Robert.Peck@sth.nhs.uk.
authors.forename: Robert
authors.initials: R
authors.lastname: Peck
authors.affiliation: Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. fred.lee@sth.nhs.uk.
authors.forename: Frederick
authors.initials: F
authors.lastname: Lee
authors.affiliation: Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. S.Goode@sheffield.ac.uk.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Goode
mesh_terms: D000368:Aged; D001659:Biliary Tract / Q000000981:diagnostic imaging; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002758:Cholangiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Bile duct; Embolization; Haemorrhage; Liver tract embolisation; PTC; Stent