In:
The British Journal of Radiology, British Institute of Radiology, Vol. 93, No. 1108 ( 2020-04), p. 20190637-
Abstract:
To retrospectively evaluate the safety and efficacy of transcatheter arterial embolization (TAE) for delayed arterial bleeding secondary to percutaneous self-expandable metallic stent (SEMS) placement in patients with malignant biliary obstruction (MBO). Methods: From January 1997 to September 2017, 1858 patients underwent percutaneous SEMS placement for MBO at a single tertiary referral center. Among them, 19 patients (mean age, 70.2 [range, 52–82] years; 13 men) presented with delayed SEMS-associated arterial bleeding and underwent TAE. Results: The incidence of delayed arterial bleeding was 1.0% (19/1858) after SEMS placement, with a median time interval of 225 days (range, 22–2296). Digital subtraction angiography (DSA) showed pseudoaneurysm alone close to the stent mesh (n = 10), pseudoaneurysm close to the stent mesh with contrast extravasation to the duodenum (n = 3), pseudoaneurysm close to the stent mesh with arteriobiliary fistula (n = 1), in-stent pseudoaneurysm alone (n = 4) and in-stent pseudoaneurysm with arteriobiliary fistula (n = 1). Bleeding was stopped after the embolization in all patients. Overall clinical success rate was 94.7% (18/19). One patient with recurrent bleeding was successfully treated with a second embolization. Overall 30-day mortality rate was 26.3% (5/19). A major procedure-related complication was acute hepatic failure in one hilar bile duct cancer patient (5.3%), which was associated with an obliterated portal vein. Conclusion: TAE is safe and effective for the treatment of delayed arterial bleeding after percutaneous SEMS placement for MBO. Advances in knowledge: This study demonstrated TAE is safe and effective for arterial bleeding after SEMS placement after MBO through the largest case series so far.
Type of Medium:
Online Resource
ISSN:
0007-1285
,
1748-880X
DOI:
10.1259/bjr.20190637
Language:
English
Publisher:
British Institute of Radiology
Publication Date:
2020
detail.hit.zdb_id:
1468548-6
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