Interventional Radiology Options after Visceral Surgery

Abstract

<b><i>Background:</i></b> Postoperative management of patients undergoing visceral surgery can present challenging clinical situations with significant morbidity and mortality. Interventional radiological techniques offer quick, safe, and effective minimally invasive treatment options in the postoperative management of visceral surgery. <b><i>Summary:</i></b> Most commonly done procedures include – but are not limited to – fluid or abscess drainage, biliary diversion, bleeding embolization, and re-canalization of a thrombosed vessel. While bleeding from side branches after hepatobiliary and pancreatic surgeries can be managed by coil embolization, the hepatic arterial injury should be managed by stent-graft placement. Hepatic venous complications can require a transhepatic or transjugular approach, whereas the transjugular intrahepatic portosystemic shunt approach has a higher clinical success rate in patients with portal vein thrombosis. Biliary leakages require multidisciplinary management, and interventional radiology can offer an efficient treatment, especially in patients with biliodigestive anastomosis. <b><i>Key Messages:</i></b> Interventional radiology provides a broad spectrum of procedures in the management of patients with recent visceral surgery.

Minimally Invasive Management of Postoperative Complications in Patients with Cholangiocarcinoma

“…Late thrombosis, presenting more than 4 weeks after transplant, is more indolent. [14][15][16][17] Revascularization with catheter-directed thrombolysis may be attempted if a significant clot burden threatens the integrity of the liver remnant or transplant. Catheter-directed infusion of tissue plasminogen activator may be considered with continuous monitoring and frequent laboratory evaluation to assess graft function.…”

“…15 There are multiple embolic agents available and are utilized for different indications. 14,[32][33][34] Hemorrhage from larger vessels is often managed with stent-graft placement to achieve hemostasis while preserving blood flow to the liver remnant or transplant (►Fig. 1).…”

Postoperative Management in Visceral Medicine

“…Deniz and colleagues [5] report that postoperative management after complex and challenging visceral procedures in certified high-volume centers can benefit from an additional high expertise in interventional radiology. With the technical developments and advancements in minimally invasive procedures, interventional radiology provides a broad spectrum of procedures in the management of patients with postoperative complications such as bleeding, vascular stenoses, or abscess formations.…”