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

Abstract

PurposeWe evaluated the safety and efficacy of transhepatic tract embolisation after a biliary intervention using n-butyl cyanoacrylate (NBCA) and autologous blood.Materials and MethodsBetween January 2017 and December 2018, 42 consecutive patients (mean age: 71\u2009±\u200915\xa0years, 24 men) with malignant (n\u2009=\u200926) or benign (n\u2009=\u200916) biliary obstructions underwent percutaneous biliary intervention followed by tract embolisation within 2\xa0weeks. 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\xa0days (range 3–14\xa0days). Glue-cast formation via fluoroscopy and immediate complications were reviewed retrospectively in medical records. Follow-up data (median: 135, range 11–720\xa0days) including computed tomography (CT) images (n\u2009=\u200917) were evaluated for delayed complications and glue-cast formation.ResultsSuccessful 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\u2009≤\u20095) immediately after embolisation, which was controlled by analgesics. Two patients had transient fever. Segmental (n\u2009=\u200911) or sub-segmental (n\u2009=\u20096) 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.ConclusionTranshepatic parenchymal tract embolisation with NBCA and autologous blood is a safe and feasible method for preventing bile leakage.Level of EvidenceLevel 4, Case Series.