Treatment of Hemobilia with Selective Hepatic Artery Embolization

doi:10.1016/S1051-0443(95)71187-3

Journal of Vascular and Interventional Radiology

Volume 6, Issue 5, September 1995, Pages 793-798

https://doi.org/10.1016/S1051-0443(95)71187-3 Get rights and content

Purpose

To evaluate retrospectively the results of selective trans-catheter embolization in the treatment of hemobilia.

Patients and Methods

Twelve patients with hemobilia (mean age, 43 years) underwent embolotherapy. Causes of hepatic vascular injury were iatrogenic trauma, blunt external trauma, septic emboli, and lupus vasculitis. A 5-F cobra catheter or a 5-F non-tapered Simmons shaped catheter passed over a hydrophilic guide wire, or a Tracker 18 catheter forming a coaxial system was used. Embolic agents included gelatin sponge or polyvinyl alcohol fragments used alone or with coils.

Results

Hepatic artery pseudoaneurysms were found in 10 patients, ruptured hepatic artery aneurysm was found in one, and ar-terioportal fistula was found in two (with pseudoaneurysm in one). Bleeding was immediately controlled in 11 of 12 patients after embolization; one patient rebled and underwent surgery. Two patients underwent repeat embolization (2 weeks and 2 months later). Two patients died, one of biliary sepsis and liver insufficiency 24 hours after embolization and the other of gangrenous cholecystitis.

Conclusion

Transcatheter embolization is an effective treatment of hemobilia. It allows control of bleeding and identification of the origin of the hemorrhage.

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There are more references available in the full text version of this article.

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Citation Excerpt :
Given the significant comorbidities associated with liver resection, endovascular interventions have become the primary treatment modality for these intrahepatic lesions when feasible. Complications of embolization include hepatic ischemia, abscess, cholecystitis, and possible recanalization.151,161,162 Coil embolization is discouraged in patients with large parenchymal lesions or if large segments of liver are at risk of ischemia.
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We report a 64-year-old man who presented with upper gastrointestinal bleeding that was complicated by shock secondary to hemobilia. He had passed tarry stools for two days. In the previous month, the patient had undergone surgery for biliary lithiasis with acute cholangitis. Despite two consecutive upper endoscopies on two successive days, the patient remained hemodynamically unstable. Computed tomography and angiography subsequently revealed an outpouching lesion as a pseudoaneurysm from the orifice of the middle hepatic artery. Hemostasis was achieved by angioembolization of the middle hepatic pseudoaneurysm. The patient had a stable level of hemoglobin by discharge. Hemorrhagic shock resulting from hepatic pseudoaneurysm is difficult to diagnose and has a high mortality rate. We were able to make the diagnosis quickly and treat him successfully with percutaneous embolization.
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Embolization is effective in this very difficult cohort of patients with outcomes similar to surgery.

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^☆: From the Section of Vascular and Interventional Radiology, Department of Diagnostic Radiology, Ciutat Sanitària i Universitària de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain.

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Vascular TherapyTreatment of Hemobilia with Selective Hepatic Artery Embolization☆

Purpose

Patients and Methods

Results

Conclusion

JVIR

JVIR

Control of hemobilia by embolization of a false aneurysm of arterioportobiliary fistula of the hepatic artery

AJR

Interventional treatment of hepatic arterial and venous pathology: a commentary

Cardiovasc Intervent Radiol

Hemobilia: hallazgos en ecografía y TC

Radiologia

Hemobilia (biliary tract hemorrhage): history, pathology, diagnosis and treatment

Iatrogenic hemobilia: how to approach it

Hepatogastroenterology

Delayed massive hemobilia following percutaneous liver biopsy: treatment by embolotherapy

Am J Gastroenterol

Biliary catheter drainage complicated by hemobilia: treatment by balloon embolotherapy

Radiology

Vascular Therapy
Treatment of Hemobilia with Selective Hepatic Artery Embolization☆