Sanghyun Choi, Presenter: Nothing to Disclose

Dong Il Gwon, Abstract Co-Author: Nothing to Disclose

Gi-Young Ko MD, Abstract Co-Author: Nothing to Disclose

Kyu-Bo Sung MD, Abstract Co-Author: Nothing to Disclose

Jin Hyung Kim MD, Abstract Co-Author: Nothing to Disclose

Hyun-Ki Yoon, Abstract Co-Author: Nothing to Disclose

To analyze the risk factors associated with hepatic artery injury (HAI) in patients who underwent percutaneous transhepatic biliary drainage (PTBD), and to evaluate the treatment outcomes of transcatheter arterial embolization (TAE).

This study was approved by the Institutional Review Board of our institution, and written informed consent was waived. From 2003 to 2008, 3110 patients (1875 males, 1235 females; age range, one to 98 years) who underwent 3780 PTBDs (right-side, 2438; left-side, 1342) were included in this study. The risk factors associated with HAI and the treatment outcomes of TAE were retrospectively analyzed. The incidence of HAI was determined, and the demographic, pathologic, technical, and laboratory variable factors were then evaluated. Factors associated with HAI were analyzed using univariate and multivariate regression analysis. Hepatic angiography was performed to identify the bleeding focus, and TAE was subsequently performed using gelfoam, coil or glue.

The incidence of HAI following PTBD was 1.9% (72/3780), and the mean onset day of HAI was 29 days-following PTBD. Univariate regression analysis showed underlying benign diseases (OR, 2.36; p = .001), an international normalization ratio (INR) more than 1.5 (OR, 2.54; p = .032), and left-sided PTBD (OR, 2.06; p = .002) were all risk factors associated with HAI. However, multivariate regression analysis confirmed that left-sided PTBD (OR, 2.02; p = .004) was the only independent factor associated with HAI. Several types of HAI, such as hepatic arterial pseudoaneurysm (n=24), fistula between the hepatic artery and the bile duct (n=31), and arterioportal shunt (n=9) were detected. All 72 patients with HAIs were successfully treated by TAE and experienced no complications.

In this large series, left-sided PTBD was significantly associated with hepatic arterial injury. Therefore, right-sided PTBD is preferable unless there is a technical difficulty or secondary intervention necessitatating left-sided PTBD and TAE is an effective treatment for HAI following PTBD.

Right-sided PTBD is preferable unless there is a technical difficulty or secondary intervention necessitatating left-sided PTBD.

Choi, S, Gwon, D, Ko, G, Sung, K, Kim, J, Yoon, H, Hepatic Arterial Injuries in 3110 Patients Who Underwent Percutaneous Transhepatic Biliary Drainage: Risk Factor Analysis and Treatment Outcomes of Transcatheter Arterial Embolization.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9010275.html