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Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile?

  • Clinical Investigation
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Abstract

Purpose

PTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique.

Materials and Methods

Haemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010 and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan–Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test.

Results

Haemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC.

Conclusion

Introduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract.

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Conflict of interest

Adam P. Dale, Rafeh Khan, Anup Mathew, Naomi O. Hersey, Robert Peck, Frederick Lee and Stephen D. Goode declare that they have no conflict(s) of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects.

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Authors and Affiliations

  1. Department of Medical Microbiology, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK

    Adam P. Dale

  2. Department of Radiology, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    Rafeh Khan, Anup Mathew, Naomi O. Hersey, Robert Peck & Frederick Lee

  3. Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    Stephen D. Goode

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  1. Adam P. Dale
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  2. Rafeh Khan
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  3. Anup Mathew
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  4. Naomi O. Hersey
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  5. Robert Peck
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  6. Frederick Lee
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  7. Stephen D. Goode
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Correspondence to Stephen D. Goode.

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Dale, A.P., Khan, R., Mathew, A. et al. Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile?. Cardiovasc Intervent Radiol 38, 1244–1251 (2015). https://doi.org/10.1007/s00270-015-1058-7

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  • DOI: https://doi.org/10.1007/s00270-015-1058-7

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