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Transhepatic Tract Embolisation After Biliary Intervention Using n-Butyl Cyanoacrylate and Autologous Blood: A Retrospective Analysis of 42 Patients

  • Jung Min Hwang
  • Jong Hyun Byeon
  • Dong Jae ShimEmail author
  • Sun Ki Kim
  • Yu Ri Shin
  • Ki Jun Kim
Technical Note Biliary
  • 17 Downloads
Part of the following topical collections:
  1. Biliary

Abstract

Purpose

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.

Results

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.

Conclusion

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.

Keywords

Transhepatic tract embolisation Stents N-butyl cyanoacrylate 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Statement

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.

IRB Approval

Our institutional review board approved this retrospective study (Incheon St. Mary Hospital: OC18RESI0059).

Supplementary material

Video 1

One drop of pure n-butyl cyanoacrylate in bile. Polymerisation takes > 10 seconds (MP4 5144 kb)

Video 2

One drop of pure n-butyl cyanoacrylate in blood. Polymerisation takes ~ 1 second (MP4 1375 kb)

Video 3

One drop of pure n-butyl cyanoacrylate in normal saline. Polymerisation takes > 14 seconds, and casts are barely identified (MP4 6092 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of Radiology, Incheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaBupyeong-gu, IncheonRepublic of Korea

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