Coil embolization of ruptured intrahepatic pseudoaneurysm through percutaneous transhepatic biliary drainage

Abstract

A 75-year-old man with chronic cholangitis and a common bile duct stone that was not previously identified was admitted for right upper quadrant pain. Acute cholecystitis with cholangitis was suspected on abdominal computed tomography (CT); therefore, endoscopic retrograde cholangiopancreatography with endonasal biliary drainage was performed. On admission day 5, hemobilia with rupture of two intrahepatic artery pseudoaneurysms was observed on follow-up abdominal CT. Coil embolization of the pseudoaneurysms was conducted using percutaneous transhepatic biliary drainage. After several days, intrahepatic artery pseudoaneurysm rupture recurred and coil embolization through a percutaneous transhepatic biliary drainage tract was conducted after failure of embolization via the hepatic artery due to previous coiling. After the second coil embolization, a common bile duct stone was removed, and the patient presented no complications during 4 months of follow-up. We report a case of intrahepatic artery pseudoaneurysm rupture without prior history of intervention involving the hepatobiliary system that was successfully managed using coil embolization through percutaneous transhepatic biliary drainage.

Percutaneous Trans-Hepatic Embolization of an Iatrogenic Extra-Hepatic Pseudoaneurysm of the Right Hepatic Artery in a Patient With Previous Occlusion of the Proper Hepatic Artery: An Endovascular Procedure to Avoid a Difficult Surgical Repair

“…Percutaneous transhepatic PsA embolization, using a cyanoacrylate-based glue or coils, has already been described in the literature for intra-hepatic PsA 1,2,3 ; in our case the technique was effective also in an extra-hepatic PsA, the latter having a major risk of rupture and consequent hemoperitoneum when compared to intra-hepatic PsA. In our patient, we decided to perform the embolization using a mix of Lipiodol® and Glubran®2.…”

“…Hepatic pseudoaneurysm (PsA) formation is a possible complication of liver biopsies or percutaneous biliary procedures, usually treated by minimally invasive interventional procedures using an endovascular and/or percutaneous trans-hepatic approach. 1-4 We present a case of successful percutaneous trans-hepatic embolization of an iatrogenic extra-hepatic PsA of the right hepatic artery (RHA) in a patient with previous occlusion of the proper hepatic artery (PHA) using a mixture of Lipiodol® (Guerbet, Roissy, France) and cyanoacrylate-based glue (Glubran®2) (GEM, Italy) under combined fluoroscopic and ultrasonographic guidance.…”

The efficacy and clinical outcomes of transarterial embolization in acute massive upper gastrointestinal bleeding: a single-center experience

“…HAP usually occurs as a result of surgical and interventional procedures applied to the biliary tract or develops secondary to trauma. Today, parallel to the increase in percutaneous interventions for the biliary tract, there is an increase in the incidence of pseudoaneurysms observed [13].…”

Cholangitis after Hemobilia: A Brief Overview

“…Placement of a covered stent allows maintaining vessel patency and avoid a liver necrosis complication [43,44]. Further, trans biliary coil embolization is a limited approach when arterial embolization is not feasible due to preclusive anatomic factors and/or a previously inserted coil through the artery [10,15].…”