Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments

Quencer, Keith; Tadros, Anthony; Marashi, K.; Cizman, Ziga; Reiner, Eric J.; O’Hara, Ryan; Öklü, Rahmi

doi:10.3390/jcm7050094

Cited by 38 publications

(32 citation statements)

References 51 publications

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“…The various procedures are described in Table 2. Most of the procedures ( n = 45; 62.72%) posed a high risk of bleeding, including orthopedic surgery, major abdominal surgery, percutaneous trans hepatic cholocystostomy, and urgent vascular surgery [21, 22]. Drug levels were obtained in 11 out of 62 (18%) patients before surgery.…”

Section: Resultsmentioning

confidence: 99%

Prothrombin Complex Concentrate before Urgent Surgery in Patients Treated with Rivaroxaban and Apixaban

et al. 2019

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Introduction: Patients treated with direct Xa inhibitors may require urgent surgery. Administration of prothrombin complex concentrate (PCC) in this setting is common; however, it is based on limited experience in healthy volunteers. Objective: To characterize the population receiving PCC for apixaban/rivaroxaban reversal prior to an urgent surgery and evaluate its efficacy and safety. Methods: This was a retrospective study in 2 tertiary hospitals. Bleeding was evaluated based on surgical reports, hemoglobin drop, and the use of blood products or additional PCC during 48 h. Safety measures were thrombotic complications and 30-day mortality. Results: Sixty-two patients aged 80.7 ± 9 years, treated with apixaban (39.63%) or rivaroxaban (23.37%), received PCC before an urgent surgery/procedure. Most underwent abdominal operation (61%), orthopedic surgery (13%), or transhepatic cholecystostomy insertion (10%). Bleeding during surgery was reported in 3 patients (5%), no patient required additional PCC, and 16 patients (26%) received packed cells (median: 1 unit, range: 1–5). The 30-day mortality and thrombosis rates were 21% (n = 13) and 3% (n = 2), respectively. The cause of death was related to the primary disease, most commonly sepsis. No patient died due to bleeding/thrombosis. Conclusions: Our results support the use of PCC to achieve hemostasis in patients treated with Xa inhibitors prior to an urgent surgery.

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Section: Resultsmentioning

confidence: 99%

Prothrombin Complex Concentrate before Urgent Surgery in Patients Treated with Rivaroxaban and Apixaban

et al. 2019

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“…9 There are reported complications and difficulties in percutaneous retrieval of fractured guidewires mainly bleeding and technical failure due to bleeding. 10 But there are no cases reported on surgical management of broken PTBD wire and redo hepaticojejunostomy done simultaneously.…”

Section: Discussionmentioning

confidence: 99%

Rare case of removal of intrabiliary retained broken PTBD wire with redo-hepaticojejunostomy

Gupta

2019

Int Surg J

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This is a rare case of surgical removal of intrahepatic retained broken wire of percutaneous transheaptic biliary catheter, which caused cholagitis and severe pain in a 59-year-old female who had undergone percutaneous transhepatic biliary dilatation of stricture hepaticojejunostomy in past. This is rare case ever reported of surgical removal of a broken PTBD wire retained inside left biliary system, post percutaneous transhepatic biliary dilatation of biliary stricture. Patient also underwent redo-hepaticojejunostomy for treatment of stricture hepaticojejunostomy in same sitting. This guidewire was put by interventional radiologist for dilatation of hepaticojejunostomy stricture. Patient had developed stricture in hepaticojejunotostomy which was done in year 2007 along with choledochal cyst excision by some other Gastrosurgeon. But one reoperation as well as one interventional approach had failed to retrieve the wire retained in biliary system. After that we successfully operated this challenging case and cured her of stricture hepaticojejunostomy, cholagitis and removed the foreign body in one surgery. Postoperatively we followed her up of 2 yrs. Patient is afebrile ,free of jaundice and has normal LFT on 2 yrs of follow up.Broken guidewire during percutaneous intervention in obstructed biliary system is an emergency as it acts as foreign body, removal with reansatomosis gives a fair chance of cholangitis free survival to patient.

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“…However, meta-analysis found PTBD to be more likely to cause bleeding (OR 1.81) and tube dislocation (OR 3.41). Traumatic complications of PTBD include injury to the hepatic artery or portal vein, bile leak, and duodenal perforation (21,22). Studies of PTBD catheter placements reported an overall complication rate of ranging from 5.2-10.8% (20,23) (Figure 5).…”

Section: Percutaneous Transhepatic Biliary Drainage (Ptbd)mentioning

confidence: 99%

Narrative review of vascular iatrogenic trauma and endovascular treatment

Smith¹,

Gage²,

Quencer³

2021

Ann Transl Med

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Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.

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Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments

Cited by 38 publications

References 51 publications

Prothrombin Complex Concentrate before Urgent Surgery in Patients Treated with Rivaroxaban and Apixaban

Prothrombin Complex Concentrate before Urgent Surgery in Patients Treated with Rivaroxaban and Apixaban

Rare case of removal of intrabiliary retained broken PTBD wire with redo-hepaticojejunostomy

Narrative review of vascular iatrogenic trauma and endovascular treatment

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