title: Acute and delayed bleeding requiring embolization after image-guided liver biopsy in patients with cancer.
abstract: OBJECTIVE
  To report incidence of acute versus delayed presentations of bleeding requiring embolization after focal liver biopsy, in correlation with angiographic findings and treatment success rates. The available literature will be reviewed as well.
  
  
  METHODS
  Health Insurance Portability and Accountability Act-compliant institutional review board approved retrospective review of 2180 consecutive patients undergoing 2335 targeted liver biopsies at a tertiary-care cancer center. Hepatic arterial embolization episodes within 30days from biopsy were identified via radiology PACS. Electronic medical record review was performed for indication of embolization and postembolization clinical course.
  
  
  RESULTS
  The incidence of postbiopsy bleeding requiring embolization was 0.5% (12/2335 biopsies). In those with bleeding, 1/12 (8%) had no hepatic arterial findings at angiography. Angiographic hepatic arterial findings resolved after embolization in 11/11 patients (100% technical success). Bleeding ceased after embolization in 10/12 patients (83% clinical success). Complications were seen in 2/12 (17%) patients: cholecystitis and hepatic infarct, respectively. Delayed presentation of bleeding (defined as >24h postbiopsy) occurred in 5/12 (42%) patients; the longest latency was 12days.
  
  
  CONCLUSIONS
  The overall incidence of bleeding requiring embolization in our population was 0.5%. This complication rate compares favorably to the 0-4.2% (median: 0.29%) rate quoted in the available, heterogeneous, literature on this topic. Delayed presentation occurred in almost half of patients. Arterial embolization carries excellent technical and clinical success rates.
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Division of Interventional Radiology, Department of Radiology, Koç University School of Medicine, Istanbul, Turkey. Electronic address: asag@ku.edu.tr.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Sag
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Brody
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Majid
authors.initials: M
authors.lastname: Maybody
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Erinjeri
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Interventional Radiology, Peking University Cancer Hospital and Institute and Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Radiology, Medical University of Graz, Graz, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wimmer
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Silk
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Elena N
authors.initials: EN
authors.lastname: Petre
authors.affiliation: Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects*; D015994:Incidence; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D008113:Liver Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Embolization, Therapeutic; Hemorrhage; Image-guided biopsy; Radiology, Interventional