Endovascular management for significant iatrogenic portal vein bleeding
- Authors
- Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K.; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo
- Issue Date
- Nov-2017
- Publisher
- SAGE PUBLICATIONS LTD
- Keywords
- Portal vein bleeding; endovascular management; iatrogenic; liver-penetrating procedure; embolization
- Citation
- ACTA RADIOLOGICA, v.58, no.11, pp.1320 - 1325
- Journal Title
- ACTA RADIOLOGICA
- Volume
- 58
- Number
- 11
- Start Page
- 1320
- End Page
- 1325
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/5490
- DOI
- 10.1177/0284185117693458
- ISSN
- 0284-1851
- Abstract
- Background: Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose: To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods: During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results: Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatmentrelated complications or patient mortality within 30 days. Conclusion: Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.
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