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Emergency percutaneous treatment in iatrogenic hepatic arterial injuries

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Abstract

The purpose of this report is to present our experience in the emergency percutaneous treatment of patients with iatrogenic hepatic arterial injury (IHAI). Seven patients (six men, one woman; age range 19–78 years; mean age 63 years) with IHAI secondary to surgical or percutaneous procedures were treated with endovascular percutaneous procedures. We performed six transhepatic arterial embolization (TAE) and one placement of an endograft stent. Follow-up was carried out by ultrasound (US) or computed tomography (CT) after 1, 3, 6, and 12 months, yearly thereafter and by laboratory tests in the first 6 months to completely exclude occult and asymptomatic bleeding. All procedures had 100% technical success. No case of further bleeding was seen at follow-up. In one patient, we detected one abscess after 3 weeks, which was treated by antibiotic therapy. In conclusion, endovascular treatment currently represents a valid option in emergency settings, as it the enables diagnosis and treatment of IHAI in a single session.

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References

  1. Miyamoto N, Kodama Y, Endo H et al (2003) Hepatic artery embolization for postoperative hemorrhage in upper abdominal surgery. Abdom Imaging 28:347–353

    Article  CAS  PubMed  Google Scholar 

  2. Shibata T, Sagoh T, Ametani F et al (2002) Transcatheter microcoil embolotherapy for ruptured pseudoaneurysm following pancreatic and biliary surgery. Cardiovasc Interv Radiol 25(3):180–185

    Article  Google Scholar 

  3. Schick C, Ritter RG, Balzer JO et al (2004) Hepatic artery aneurysm: treatment options. Eur Radiol 14(1):157–159

    Article  PubMed  Google Scholar 

  4. Basile A, Lupattelli T, Giulietti G et al (2005) Interventional treatment of iatrogenic lesions and hepatic arteries. Radiol Med 110(1–2):88–96

    PubMed  Google Scholar 

  5. Carrafiello G, Laganà D, Ianniello A et al (2007) Bleeding after percutaneous radiofrequency ablation: successful treatment with transcatheter embolization. Eur J Radiol 61(2):351–355

    Article  PubMed  Google Scholar 

  6. Green MHA, Duell RM, Johnson CD et al (2001) Hemobilia. Br J Surg 88(6):773–786

    Article  CAS  PubMed  Google Scholar 

  7. L’Hermine C, Ernst O, Delemazure O et al (1996) Arterial complications of percutaneous transhepatic biliary drainage. Cardiovasc Interv Radiol 19(3):160–164

    Article  CAS  Google Scholar 

  8. Deziel DJ, Millikan KW, Economou SG et al (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165:9–14

    Article  CAS  PubMed  Google Scholar 

  9. Nicholson T, Travis S, Ettles D et al (1999) Hepatic artery angiography and embolization for hemobilia following laparoscopic cholecystectomy. Cardiovasc Interv Radiol 22(1):20–24

    Article  CAS  Google Scholar 

  10. Turrion VS, Alvira LG, Jimenez M et al (2002) Incidence and results of arterial complications in liver transplantation: experience in a series of 400 transplants. Transplant Proc 34:292–293

    Article  CAS  PubMed  Google Scholar 

  11. Settmacher U, Stange B, Haase R et al (2000) Arterial complications after liver transplantation. Transpl Int 13:372–378

    Article  CAS  PubMed  Google Scholar 

  12. Sanchez-Bueno F, Robles R, Acosta F et al (2000) Hepatic artery complications in a series of 300 orthotopic liver transplants. Transplant Proc 32:2669–2670

    Article  CAS  PubMed  Google Scholar 

  13. Vivas S, Palacio MA, Lomo J et al (1998) Arterioportal fistula and hemobilia in a patient with hepatic transplant. Gastroenterol Hepatol 21:88–89

    CAS  PubMed  Google Scholar 

  14. De Diego Lorenzo A, Gonzalez-Asanza C, Castellote VI et al (1995) Ischemic hepatitis following liver biopsy in a patient with transplanted liver. Rev Esp Enferm Dig 87:739–742

    PubMed  Google Scholar 

  15. Otobe Y, Hashimoto T, Shimizu Y et al (1995) Formation of a fatal arterioportal fistula following needle liver biopsy in a child with a living-related liver transplant: report of a case. Surg Today 25:916–919

    Article  CAS  PubMed  Google Scholar 

  16. Okuda K, Musha H, Nakajima Y et al (1978) Frequency of intrahepatic arteriovenous fistula as a sequela to percutaneous needle puncture of the liver. Gastroenterology 74:1204–1207

    CAS  PubMed  Google Scholar 

  17. Lee SJ, Lim JH, Lee WJ et al (1997) Transient subsegmental hepatic parenchymal enhancement on dynamic CT: a sign of postbiopsy arterioportal shunt. J Comput Assist Tomogr 21:355–360

    Article  CAS  PubMed  Google Scholar 

  18. Tessier DJ, Fowl RJ, Stone WM et al (2003) Iatrogenic hepatic artery pseudoaneurysms: an uncommon complication after hepatic, biliary, and pancreatic procedures. Ann Vasc Surg 17(6):663–669

    Article  PubMed  Google Scholar 

  19. Mohr AM, Lavery RF, Barone P et al (2003) Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma 55:1077–1082

    Article  PubMed  Google Scholar 

  20. Okuno A, Miyazaki M, Ito H et al (2001) Nonsurgical management of ruptured pseudoaneurysm in patients with hepatobiliary pancreatic diseases. Am J Gastroenterol 96:1067–1071

    Article  CAS  PubMed  Google Scholar 

  21. Cullen JJ, Sarr MG, Ilstrup DM (1994) Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am J Surg 168:295–298

    Article  CAS  PubMed  Google Scholar 

  22. Reber PU, Baer HU, Patel AG et al (1998) Life-threatening upper gastrointestinal tract bleeding caused by ruptured extrahepatic pseudoaneurysm after pancreatoduodenectomy. Surgery 124:114–115

    CAS  PubMed  Google Scholar 

  23. Salam TA, Lumsden AB, Martin LG et al (1992) Nonoperative management of visceral aneurysms and pseudoaneurysms. Am J Surg 164:215–219

    Article  CAS  PubMed  Google Scholar 

  24. Iseki J, Touyama K, Noie T et al (1992) Partial portal arterialization for the prevention of massive liver necrosis following extended pancreatobiliary surgery: experience of two cases. Surg Today 22:568–571

    Article  CAS  PubMed  Google Scholar 

  25. Tarazov FG (1993) Intrahepatic arterioportal fistulae: role of transcatheter embolization. Cardiovasc Interv Radiol 16(6):368–373

    Article  CAS  Google Scholar 

  26. Rivitz MS, Waltman CA, Kelsey PB (1996) Hembolization of an hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Cardiovasc Interv Radiol 19:43–46

    Article  CAS  Google Scholar 

  27. Yamakado K, Nakatsuka A, Tanaka N et al (2000) Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol 11:66–72

    Article  CAS  PubMed  Google Scholar 

  28. Kitagawa T, Iriyama K, Azuma T et al (1997) Nonoperative treatment for a ruptured pseudoaneurysm of the celiac trunk: report of a case. Surg Today 27:1069–1073

    Article  CAS  PubMed  Google Scholar 

  29. Larson RA, Solomon J Carpenter JP (2002) Stent graft repair of visceral artery aneurysms. J Vasc Surg 36(6):1260–1263

    Article  PubMed  Google Scholar 

  30. Bilbao J, Torres E, Martinez-Cuesta A (2002) Non traumatic abdominal emergencies: imaging and intervention in gastrointestinal hemorrhage and ischemia. Eur Radiol 12(9):2161–2171

    PubMed  Google Scholar 

  31. Carrafiello GP, Laganà D, Recaldini C, Mangini M et al (2007) Combined percutaneous thrombin injection and endovascular treatment of gastroduodenal artery pseudoaneurysm (PAGD). Emerg Radiol 14:51–54

    Article  PubMed  Google Scholar 

  32. Torres E, Benito A, Cano D et al (2001) Vascular complications after hepatic tumor radiofrequency. Eur Radiol 11(Suppl A):410

    Google Scholar 

  33. Jander HP, Laws HL, Kogutt MS et al (1977) Emergency embolization in blunt hepatic trauma. Am J Roentgenol 129(2):249–252

    CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Insubria, 21100, Varese, Italy

    Gianpaolo Carrafiello, Domenico Laganà, Massimiliano Dizonno, Elisa Cotta, Andrea Ianniello & Carlo Fugazzola

Authors
  1. Gianpaolo Carrafiello
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  2. Domenico Laganà
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  3. Massimiliano Dizonno
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  4. Elisa Cotta
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  5. Andrea Ianniello
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  6. Carlo Fugazzola
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Correspondence to Massimiliano Dizonno.

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Carrafiello, G., Laganà, D., Dizonno, M. et al. Emergency percutaneous treatment in iatrogenic hepatic arterial injuries. Emerg Radiol 15, 249–254 (2008). https://doi.org/10.1007/s10140-008-0715-4

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  • DOI: https://doi.org/10.1007/s10140-008-0715-4

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