Vascular complications associated with percutaneous biliary drainage: a report of three cases

Abstract

Percutaneous biliary drainage is a common interventional radiology procedure. It is usually performed in the setting of biliary obstruction, benign or malignant, after endoscopic approach failed or is technically not possible. Percutaneous biliary drainage has a relatively low complication rate, and most complications that occur are usually self-limited. Major complications, however, can occur. In this article, we report three major hemorrhagic complications and their management. They include hemorrhage secondary to fistula formation and pseudoaneurysm formation occurring several days to weeks subsequent to the initial drain placement.

Keywords: Pseudoaneurysm; complication; fistula; percutaneous biliary drainage.

Figure 1

Injection of the biliary drain demonstrates an iatrogenic portal vein to biliary duct fistula.

Figure 2

Contrast injection through a hemostatic sheath placed over a wire shows an unusual case of portal vein to hepatic vein fistula. Note that several embolization coils are also present from arterial embolization earlier that day. All injuries lie in the course of the biliary drain.

Figure 3

(A) Right hepatic arteriogram shows a small aneurism originating from the branch vessel. Vascular tumor blush in this patient with hepatocellular carcinoma is also present. (B) Right hepatic arteriogram demonstrates filling of the pseudoaneurysm and abnormal filling of the central bile ducts. (C) Hepatic arteriogram after the deposition of several coils shows absence of pseudoaneurysm opacification.