Transhepatic Tract Embolisation After Biliary Intervention Using n-Butyl Cyanoacrylate and Autologous Blood: A Retrospective Analysis of 42 Patients
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We evaluated the safety and efficacy of transhepatic tract embolisation after a biliary intervention using n-butyl cyanoacrylate (NBCA) and autologous blood.
Materials and Methods
Between January 2017 and December 2018, 42 consecutive patients (mean age: 71 ± 15 years, 24 men) with malignant (n = 26) or benign (n = 16) biliary obstructions underwent percutaneous biliary intervention followed by tract embolisation within 2 weeks. Forty-six transhepatic tracts (4 bilateral) in 42 patients were embolised using a NBCA and lipiodol mixtures (1:1–1:2 ratios) after intraductal infusion of peripherally obtained autologous blood. The indwelling catheter diameters were 8.5–14 Fr. The median interval between percutaneous biliary drainage and tract embolisation was 10 days (range 3–14 days). Glue-cast formation via fluoroscopy and immediate complications were reviewed retrospectively in medical records. Follow-up data (median: 135, range 11–720 days) including computed tomography (CT) images (n = 17) were evaluated for delayed complications and glue-cast formation.
Successful glue-cast formations were achieved in all 46 tracts. No patients experienced haemorrhage, and only one patient had external bile leakage. Eight patients complained of abdominal pain (numerical scale ≤ 5) immediately after embolisation, which was controlled by analgesics. Two patients had transient fever. Segmental (n = 11) or sub-segmental (n = 6) glue-cast patterns were identified along the transhepatic tract by follow-up CT. No biliary obstructions were caused by inadvertent glue spread. Fragmented glue was detected outside the stent in one patient.
Transhepatic parenchymal tract embolisation with NBCA and autologous blood is a safe and feasible method for preventing bile leakage.
Level of Evidence
Level 4, Case Series.
KeywordsTranshepatic tract embolisation Stents N-butyl cyanoacrylate
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Our institutional review board approved this retrospective study (Incheon St. Mary Hospital: OC18RESI0059).
One drop of pure n-butyl cyanoacrylate in bile. Polymerisation takes > 10 seconds (MP4 5144 kb)
One drop of pure n-butyl cyanoacrylate in blood. Polymerisation takes ~ 1 second (MP4 1375 kb)
One drop of pure n-butyl cyanoacrylate in normal saline. Polymerisation takes > 14 seconds, and casts are barely identified (MP4 6092 kb)
- 9.Franklin GA, Richardson JD, Brown AL, Christmas AB, Miller FB, Harbrecht BG, et al. Prevention of bile peritonitis by laparoscopic evacuation and lavage after nonoperative treatment of liver injuries. Am Surg. 2007;73:611–7.Google Scholar
- 15.Goode SD, Lee F. Liver tract sealing with Hep-Plug™ sealing system improves haemorrhage control for patients undergoing transhepatic procedures. Cardiovasc Intervent Radiol. 2018;41:822–3.Google Scholar