Portal Vein Tract Embolization After Percutaneous Transhepatic Biliary Interventions

Bleeding complications during percutaneous biliary intervention result from injury to the hepatic artery, hepatic vein, or portal vein. If bleeding originating from a hepatic artery branch is suspected, hepatic arteriography should be performed with and without the drainage catheter in place over a wire, and subselective embolization can be performed if a suitable target is identified. If a bleeding hepatic artery branch is not identified, bleeding from a portal vein branch is suspected. Treatment of portal vein injuries is challenging in this situation because obtaining direct percutaneous portal vein access is ill-advised. Although injuries to the hepatic artery or vein can often be treated by tract tamponade or arterial embolization, iatrogenic communication between the portal vein and biliary system can be difficult to treat effectively. This chapter presents a method to identify portal vein-to-biliary tract communications via cholangiography, with subsequent embolization via the transhepatic tract.