Intrahepatic Biloma Formation (Bile Duct Necrosis) After Transcatheter Arterial Chemoembolization

Sakamoto, Ichiro; Iwanaga, Soji; Nagaoki, Kenji; Matsuoka, Yoshikazu; Ashizawa, Kazuto; Uetani, Masataka; Fukuda, Toshio; Okimoto, Tomoaki; Okudaira, Sadayuki; Omagari, Katsuhisa; Hayashi, Kuniaki; Matsunaga, Naofumi

doi:10.2214/ajr.181.1.1810079

Cited by 91 publications

(75 citation statements)

References 19 publications

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“…Such advantages include an easier approach, precise localization of the pseudoaneurysm, assessment of collateral pathways to the liver, less chance of re-bleeding, and low mortality rates [1][2][3][4][5][6][7] . Meanwhile, TAE on the hepatic artery may lead to liver abscesses, gallbladder necrosis, biliary stricture, intrahepatic biloma, and embolization of nor mal vessels [8][9][10] . Furthermore, hepatic TAE may cause a total interruption of the arterial blood supply to the liver, thus www.wjgnet.com presenting a risk for liver infarction, especially in patients after right or left hepatic lobectomy [11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Tajima

Kuroki²,

Tsutsumi³

et al. 2007

WJG

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AIM:To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery. METHODS:We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepatobiliary pancreatic surgery between June 1992 and April 2006. We paid special attention to the extrahepatic arterial collaterals to the liver which may affect post-TAE liver damage and patient outcome. RESULTS:The underlying diseases were all malignancies, and the surgical procedures included hepatopancreatoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenectomy in 2. A total of 11 pseudoaneurysm developed: 4 in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful hemostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery, were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection, the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arterial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic artery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE. CONCLUSION:When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral pathways to the liver created by the primary surgical procedure and a short postoperative interval may lead to an unfavorable outcome.

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Section: Introductionmentioning

confidence: 99%

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Tajima

Kuroki²,

Tsutsumi³

et al. 2007

WJG

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“…10 Martin et al discovered several risk factors to be associated with adverse events of drug-eluting beads, including lack of pretreatment with hepatic arterial lidocaine, 3 or more treatments, achievement of complete stasis, treatment with > 100 mg DEBIRI in a single treatment, and bilirubin > 2.0 mg/dL with > 50% liver involvement. 11 Biloma formation is a well-known complication of several surgical and interventional procedures including biliary surgery, liver transplantation, percutaneous cholangiography, biliary drainage, liver biopsy, 12-14 chemoembolization, chemoinfusion therapy, radiofrequency ablation, [14][15][16][17][18][19][20][21][22][23][24][25][26] cholecystectomy, 14,27,28 endoscopic retrograde cholangiopancreatography (ERCP), percutaneous ethanol injection, 14 and radioembolization. 29 A biloma is an encapsulated bile collection outside the biliary tree due to bile leakage.…”

Section: Discussionmentioning

confidence: 99%

“…Otherwise, percutaneous drainage should be considered. 29 In one of the largest studies to analyze the occurrence of biloma associated with chemoembolization, Sakamoto et al 16 chemoembolized 972 patients with gelatin sponge and anticancer drugs and reported a 3.6% overall incidence of biloma formation (3.3% in patients with HCC and 9.6% in patients with metastatic liver disease). Miyayama et al 32 also reported on the complications of chemoembolization for HCC.…”

Section: Discussionmentioning

confidence: 99%

Chemoembolization with Drug-Eluting Beads Complicated by Intrahepatic Biloma

Naumann¹,

Gupta²

2011

Semin intervent Radiol

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Chemoembolization with drug-eluting beads is a type of locoregional therapy currently being used for the treatment of hepatocellular carcinoma and metastatic disease to the liver. This treatment has proven effectiveness in controlling tumor growth, extending survival time, and improving quality of life. Chemoembolization with drug-eluting beads have been shown to be safe, but like any other invasive procedure, can have associated complications. The authors present a case of intrahepatic biloma formation occurring as a result of treatment with drug-eluting beads.

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“…To minimize the risk associated with TACE, it is important to understand the major complications of this procedure. The most common and severe complication is TACE-associated hepatic and biliary damage, which primarily consists of hepatic insufficiency, liver abscess and intrahepatic biloma formation among others (9).…”

Section: Introductionmentioning

confidence: 99%

“…Once intrahepatic biloma has developed, repeat TACE becomes more difficult and riskier in patients with HCC (9). Therefore the methods for effective prevention and treatment of intrahepatic biloma after TACE must be determined.…”

Section: Introductionmentioning

confidence: 99%

Intrahepatic biloma following transcatheter arterial chemoembolization for hepatocellular carcinoma: Incidence, imaging features and management

Zhang

Guo

et al. 2017

Molecular and Clinical Oncology

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Abstract. Repeat transcatheter arterial chemoembolization (TACE) becomes more challenging for patients with intrahepatic biloma following TACE for hepatocellular carcinoma (HCC).The purpose of this study was to investigate the clinical course, incidence, imaging features and outcome and to explore the reasonable therapy scheme for intrahepatic biloma following TACE for HCC.A total of 4,695 TACE procedures were performed for 1,923 patients with HCC. Twenty patients with intrahepatic biloma following TACE were studied retrospectively. The incidence of intrahepatic biloma was 1.04% in this study. The 20 patients underwent 55 TACE procedures (mean, 2.75). Portal vein invasion was found in half of the patients. Eleven patients developed round solitary or multiple cystic biloma, 6 patients had branched biloma and 3 patients developed both cystic and branched biloma. Percutaneous drainage was applied for 4 patients. One patient underwent partial hepatectomy and one mortality occurred due to progressive biloma and multiple organ failure. Although severe intrahepatic biloma following TACE is rare, the procedure should be performed with caution. Timely and appropriate management, including percutaneous drainage, partial hepatectomy and antibiotic administration should be performed in the case of any signs of infection.

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Intrahepatic Biloma Formation (Bile Duct Necrosis) After Transcatheter Arterial Chemoembolization

Cited by 91 publications

References 19 publications

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

Chemoembolization with Drug-Eluting Beads Complicated by Intrahepatic Biloma

Intrahepatic biloma following transcatheter arterial chemoembolization for hepatocellular carcinoma: Incidence, imaging features and management

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