Prevention and management of infectious complications of percutaneous interventions

Abstract

Infectious complications following interventional radiology (IR) procedures can cause significant patient morbidity and, potentially, mortality. As the number and breadth of IR procedures grow, it becomes increasingly evident that interventional radiologists must possess a thorough understanding of these potential infectious complications. Furthermore, given the increasing incidence of antibiotic-resistant bacteria, emphasis on cost containment, and attention to quality of care, it is critical to have infection control strategies to maximize patient safety. This article reviews infectious complications associated with percutaneous ablation of liver tumors, transarterial embolization of liver tumors, uterine fibroid embolization, percutaneous nephrostomy, percutaneous biliary interventions, central venous catheters, and intravascular stents. Emphasis is placed on incidence, risk factors, prevention, and management. With the use of these strategies, IR procedures can be performed with reduced risk of infectious complications.

Keywords: catheter-related; complication; infection; interventional radiology.

Fig. 1

Gas in the region of ablation following radiofrequency ablation (RFA) of a liver metastasis from breast carcinoma. (a) Axial image from a CT scan with contrast immediately following RFA demonstrates gas within the zone of ablation (arrow). Because of the location of the metastasis adjacent to the liver capsule and chest wall, a solution of 5% dextrose water and iodinated contrast was instilled in the perihepatic space (thin arrows). Note that the gas bubbles do not correspond to the ablation margins. (b) Axial CT image with contrast 3 months following ablation demonstrates resolution of gas. There is also no evidence of enhancing tissue to suggest residual disease.

Fig. 2

Hepatic abscess following radiofrequency ablation (RFA) of liver metastasis from pancreatic neuroendocrine carcinoma. The patient had previously undergone a Whipple procedure 2 years prior to RFA. (a) Axial image from a CT scan with contrast demonstrates a hypodense lesion near the hepatic dome (arrowheads) consistent with a hepatic metastasis. (b) Thick-slab reformatted axial CT image during ablation demonstrates the RFA probes along the medial and lateral aspects of the lesion (arrowheads). (c) Axial CT image without contrast immediately following ablation demonstrates a small focus of gas (arrow), which is normal following liver RFA. (d) Axial CT image with contrast performed 3 weeks following RFA demonstrates findings of a hepatic abscess following RFA (thin arrows): rim enhancement, low-density center, and increasing intralesional gas.

Fig. 3

Benign intralesional gas postembolization. (a) A heterogeneous enhancing mass is present in the right lobe (arrow), which was treated with bland embolization using 150–250 µm polyvinyl alcohol particles to stasis. (b) 10 days later, the patient underwent contrast-enhanced CT due to persistent abdominal pain. A nonenhancing region measuring 20 Hounsfield units containing multiple bubbles was demonstrated (arrow). The patient was otherwise afebrile without leukocytosis and had an otherwise uneventful course without antibiotic therapy.

Fig. 4

Hepatic abscess following transarterial bland embolization for metastatic neuroendocrine cancer. The patient had previously undergone a Whipple procedure 3 years prior to embolization. (a) Axial image from a CT scan during the arterial phase on enhancement demonstrates a hyperenhancing lesion in the left hepatic lobe (arrow) consistent with a hepatic metastasis. (b) Bland particle embolization of the segment 2 and 3 left hepatic artery was performed with 355–500 µm polyvinyl alcohol particles. Image from a digital subtraction angiogram demonstrates no significant residual enhancement of the left hepatic lobe lesion. (c) Axial CT image with contrast performed 3 weeks following RFA demonstrates findings of a complex hepatic abscess (thin arrows). A large extrahepatic abscess was also present (black arrow). The complex intrahepatic and extrahepatic abscesses were drained percutaneously. (d) Axial CT image performed 2 weeks following percutaneous drainage demonstrates interval resolution of both abscesses.