Biliary-Pleural Fistula following Portal Vein Embolization for Perihilar Cholangiocarcinoma

Mohammed, Mujtaba; Kobayashi, Katsuhiro; Jawed, Mohammed

doi:10.1159/000475754

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…Embolization of the percutaneous trans-hepatic access tracts of the portal vein to prevent hemorrhage has previously been reported. Various materials are utilized to embolize the access tracts after PVE, including fibrin glue, 2,8 NBCA, 9,10 gelatin sponge particles, 11,12 vascular plugs, 13 and coils. 14-17 The use of these various embolic materials will increase procedural expenditure, operation difficulty, and duration.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, in transhepatic PVE procedures, bleeding is the most common postoperative complication, occurring in approximately 2% to 4% of patients after PVE. 6,7 The risk of hemorrhage is reduced when materials such as embolization fibrin glue, 2,8 n-butyl cyanoacrylate (NBCA), 9,10 gelatin sponge particles,, 11,12 vascular plugs, 13 and coils [14][15][16][17] are used to embolize the tract. These various embolic materials not only increase procedure expenditure but also increase operation difficulty and duration.…”

Section: Introductionmentioning

confidence: 99%

“…The risk of hemorrhage is reduced when materials such as embolization fibrin glue, 2,8 n-butyl cyanoacrylate (NBCA), 9,10 gelatin sponge particles,, 11,12 vascular plugs, 13 and coils 14-17 are used to embolize the tract. These various embolic materials not only increase procedure expenditure but also increase operation difficulty and duration.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and Safety of Delayed Catheter Removal Technique in Percutaneous Trans-Hepatic Portal Vein Embolization

Yang

2022

Technol Cancer Res Treat

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Background: This retrospective study aimed to evaluate the technical feasibility and safety of the delayed catheter removal technique in trans-hepatic portal vein embolization (PVE) and to explore a suitable technique. Methods: This was a retrospective study. In 278 consecutive patients, the puncture tract of the trans-hepatic PVE was treated using the delayed catheter removal technique after PVE. The existence of peripheral hepatic hematoma formation was assessed using ultrasound (US). Follow-up examinations such as magnetic resonance imaging (MRI), computed tomography (CT), and/or US were performed to evaluate perihepatic hematoma formation, hemoperitoneum, and other major complications. Results: Instant hemostasis was achieved in all patients after the procedure. PVE-associated complications were observed in 9 patients (3.24%). No perihepatic hematoma or hemoperitoneum was found in any of the patients. Conclusion: With the appropriate technique, the delayed catheter removal technique can be reliably utilized as a substitute for hemostasis as it is simple and free. This technique should be further evaluated and compared with other methods. Advances in knowledge: This study is the first to investigate the safety and feasibility of the delayed catheter removal technique for embolizing the puncture tract of the trans-hepatic PVE.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility and Safety of Delayed Catheter Removal Technique in Percutaneous Trans-Hepatic Portal Vein Embolization

Yang

2022

Technol Cancer Res Treat

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“…Patients with hilar cholangiocarcinoma usually require liver resection and extrahepatic bile duct resection to achieve radical cure. Previous studies [ 11 , 23 , 24 ] have found that the incidence of biliary fistula after such surgery is high, and biliary fistula has adverse effects on the short-term and long-term prognosis of patients. In this study, the incidence of biliary fistula after radical resection of hilar cholangiocarcinoma was 20.63%, which was lower than that reported in the previous literatures [ 12 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Influencing factors of biliary fistula after radical resection of hilar cholangiocarcinoma: a prospect cohort

Zhang

Qi²,

Sun³

et al. 2022

Eur J Med Res

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Background Biliary fistula is a common but serious complication after radical resection of hilar cholangiocarcinoma. We aimed to evaluate the influencing factors of biliary fistula after radical resection, to provide insights to the clinical treatment of hilar cholangiocarcinoma. Methods Patients undergoing radical resection of hilar cholangiocarcinoma from January 1, 2015 to March 31, 2022 were selected. Patients’ personnel characteristics and laboratory test results of patients with and without biliary fistula were collected and compared. Logistic regression analyses were conducted to evaluate the associated risk factors of biliary fistula. Results 160 patients undergoing radical resection of hilar cholangiocarcinoma were included, the incidence of postoperative biliary fistulas was 20.63%. There were significant differences in the age, preoperative cholangitis and number of biliary anastomosis between biliary fistula and no biliary fistula patients (all p < 0.05). There were significant differences in the gamma glutamyl transpeptidase (GGT) on the first day after surgery, Klebsiella pneumoniae between biliary fistula and no biliary fistula patients (all p < 0.05). Logistic regression analysis indicated that age ≥ 65 years (OR 2.035, 95%CI 1.131–3.007), preoperative cholangitis (OR 1.584, 95% CI 1.081–2.361), number of biliary anastomosis ≥ 2(OR 2.866, 95%CI 1.942–3.624), GGT on the first day after surgery ≥ 120 U/L (OR 1.823, 95%CI: 1.274–2.906), preoperative bile culture for Klebsiella pneumoniae (OR 3.181, 95%CI: 2.426–3.992) were the risk factors of postoperative biliary fistulas (all p < 0.05). Conclusions There are many independent risk factors for postoperative biliary fistula in patients undergoing radical resection of hilar cholangiocarcinoma. Clinical medical workers should take early interventions and treatment measures for these high-risk patients to reduce the occurrence of postoperative biliary fistula.

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“…Absolute contraindications to the procedure include tumor thrombus and clinically significant portal hypertension [1] . Complications of PVE include pneumothorax, cholangitis, FLR injury, hemoperitoneum, and rarely biliary-pleural fistula in the setting of cholangiocarcinoma and obstructive jaundice [1] , [5] , [6] .…”

Section: Introductionmentioning

confidence: 99%

Intrahepatic portal-venous shunts during PVE

Sanampudi

Raissi

2018

Radiology Case Reports

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Portal venous embolization (PVE) is a well-validated technique to promote contralateral liver lobe hypertrophy prior to hepatic resection. We present a case of a patient with Type IV cholangiocarcinoma undergoing PVE prior to hepatic surgical resection. However, intrahepatic portal-venous shunts were incidentally found during the procedure and were subsequently embolized using embolic coils and N-butyl cyanoacrylate. While most patients with congenital portal-venous shunts remain asymptomatic, an unrecognized shunt during PVE could have resulted in a devastating complication secondary to nontarget embolization through the fistula.To our knowledge, this is the first reported case of a portal-venous shunt being discovered during a PVE.

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Biliary-Pleural Fistula following Portal Vein Embolization for Perihilar Cholangiocarcinoma

Cited by 6 publications

References 12 publications

Feasibility and Safety of Delayed Catheter Removal Technique in Percutaneous Trans-Hepatic Portal Vein Embolization

Feasibility and Safety of Delayed Catheter Removal Technique in Percutaneous Trans-Hepatic Portal Vein Embolization

Influencing factors of biliary fistula after radical resection of hilar cholangiocarcinoma: a prospect cohort

Intrahepatic portal-venous shunts during PVE

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