Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Hepatic Infarction following Hepatic Artery Embolization for latrogenic Hepatic Arterial Hemorrhage

의인성 간동맥 손상에 대한 간동맥 색전술 후에 발생한 간경색

  • Published : 2009.09.30

⟨ Previous Next ⟩

Abstract

Background : Hepatic artery embolization for the treatment of iatrogenic biliary hemorrhage is a safe and effective alternative to open surgery. However, treatment with hepatic artery embolization can lead to hepatic ischemia or infarction. Purpose : To examine the site, frequency and clinical presentation of hepatic ischemia following selective hepatic artery embolization. Material & methods : We reviewed medical records of 11 hepatic ischemia patients on a retrospective basis, who received treatment between January 1997 to March 2009. Results : Primary disease in 11 cases were early gastric cancer in 3 cases, chronic recurrent pancreatitis in 2 cases, choledochal cyst in 2 cases, chronic calculus cholecystitis in 2 cases, GB cancer in 1 case and recurrent HCC in 1 case. In all cases, embolized material was coil. Five cases (45.5%) resulted in hepatic abscesses and managed with percutaneous drainage, but 4 cases were died. Conclusion : Hepatic artery embolization is an effective method for the treatment of iatrogenic hepatic artery hemorrhage, but it has a high mortality due to liver infarction. For this reason, superselective embolization, or stent insertion, should be considered in high risk patients.

Keywords

References

  1. Richard A, Schwartz MD, George P, et al. Effectiveness of Transcatheter Embolization in the Control of Hepatic Vascular Injuries. J Vasc lntervent RadioI 1993;4:359-365. https://doi.org/10.1016/S1051-0443(93)71876-X
  2. Baker KS, Tisnado J, Cho SR, Beachley MC. Splanchnic artery aneurysms and pseudoaneurysms: transcatheter embolization. Radiol 1987;163;135-139. https://doi.org/10.1148/radiology.163.1.3823426
  3. Okuno A, Miyazaki M, Ito H, et al. Nonsurgical management of ruptured pseudoaneurysm in patients with hepatobiliary pancreatic diseases. Am J Gastroenterol 2001;96:1067-1071. https://doi.org/10.1111/j.1572-0241.2001.03691.x
  4. Delgadillo X, Berney T, de Perrot M, Didier D, Morel P. Successful treatment of a pseudoaneurysm of the cystic artery with microcoil embolization. J Vasc lntervent Radiol 1999;10:789-792. https://doi.org/10.1016/S1051-0443(99)70116-8
  5. Nicholson T, Travis S, Ettles D, et al. Hepatic artery angiography and embolization for hemobilia following laparoscopic cholecystectomy. Cardiovasc Intervent RadioI 1999;22:20-24. https://doi.org/10.1007/s002709900323
  6. Kim W, Clark TW, Baum RA, Soulen MC. Risk factors for liver abscess formation after hepatic chemoembolization. J Vasc lntervent RadioI 2001;12:965-968. https://doi.org/10.1016/S1051-0443(07)61577-2
  7. Trojanowski JQ, Harrist TJ, Athanasoulis TA, Greenfield AJ. Hepatic and splenic infarctions: Complications of therapeutic transcatheter embolization. Am J Surg 1980;139:272-277. https://doi.org/10.1016/0002-9610(80)90272-X
  8. Hashimoto M, Akabane Y, Heianna J, et al. Hepatic infarction following selective hepatic artery embolization with microcoils for iatrogenic biliary hemorrhage. Hepatol Res 2004;30:42-50.
  9. Reber PU, Baer HU, Patel AG, Wildi S, Triller J, Buchler MW. Superselective microcoil embolization: treatment of choice in high-risk patients with extrahepatic pseudoaneurysms of the hepatic arteries. J Am CoII Surg 1998;186:325-330. https://doi.org/10.1016/S1072-7515(98)00032-5