Bile duct necrosis: complication of transcatheter hepatic arterial embolization.

Abstract

Bile duct necrosis because of transcatheter hepatic arterial embolization (THAE) in two patients with hepatocellular carcinoma is reported. Preoperative THAE was performed on 29 patients, and bile duct necrosis was experienced by two of the 29 (7%). In these two patients, gelatin (Gelfoam) powder was used as the embolus. Among the 24 whose embolus was clear, four were embolized with gelatin powder. Therefore, incidence of bile duct necrosis after THAE with gelatin powder was 50%. Because of the hazards of severe complications such as bile duct necrosis, we conclude that gelatin powder should not be used except for the THAE of no more than one segment of the liver.

Giant Hepatic Biloma Following Transcatheter Oily Chemoembolization in a Patient with Hepatic Metastases from Malignant Pheochromocytoma.

“…Portal blood flow is maintained during embolization of the hepatic artery with Gel foam, and normally, serious complications due to ischemia do not develop, because collateral vessels are formed at an early stage (8). However, it should be clearly understood that the infusion of embolic materials consisting of smaller particles, such as Gel foam powder, silicone, or iodized oil may fill the sinusoids, and then reflux into the portal vein, possibly inducing severe ischemia (6)(7)(8). This is especially likely to happen when the catheter is wedgedinto the hepatic artery, or transcatheter arterial embolization is carried out repeatedly within a short period of time (3).…”

“…Recently, bilomas of iatrogenic origin after transcatheter arterial embolization have been reported (2,3). The small-diameter embolic material sometimes used in transcatheter arterial embolization may cause destruction of the wall of the bile duct by obstructing the peribiliary arterial plexus of the duct, resulting in leakage and subsequent pooling of the bile (4)(5)(6)(7). This is frequently preceded by hepatic infarction.…”

Management of Hepatocellular Carcinoma *

“…Gelfoam powder should be not be used as this may cause biliary damage. 314 The procedure requires the advancement of the catheter into the hepatic artery and then to lobar and segmental branches aiming to be as selective as possible so as to induce only minimal injury to the surrounding non-tumorous liver. Multifocal HCC involving both hepatic lobes may require the obstruction of the total hepatic artery blood flow.…”

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…Hepatic artery obstruction is usually achieved by Gelfoam particles, but polyvinyl alcohol, starch microspheres, metallic coils, and autologous blood clots have also been used [321]. Gelfoam powder should not be used because this may cause biliary damage [323]. In a recent study, TACE performed with drug-eluting beads loaded with doxorubicin has been shown to modify the pharmacokinetics of the injected chemotherapy, thus reducing the drug-related adverse effects while maintaining the same therapeutic efficacy as TACE [324].…”