Embolizing the liver tract ‰ÛÏa priority‰Û to improve outcomes for percutaneous transhepatic interventions

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Research presented at the Global Embolization Symposium and Technologies US (GEST US meeting, 1–4 May, San Francisco, USA) meeting suggests that patients undergoing transhepatic interventions should have tract embolization performed to prevent haemorrhagic complications.

Stephen Goode, Sheffield Vascular Institute and the University of Sheffield, UK, presented the study that was designed to identify the incidence of postprocedural haemorrhagic complications in patients undergoing percutaneous transhepatic cholangiography and to further assess the impact of using a dedicated liver tract embolization closure method on patient outcomes.

“Clinically significant post-procedure haemorrhage occurred in 12% of the cohort who did not undergo embolization for liver tract for closure. Following the incorporation of a dedicated targeted and expanding gelatine foam embolization method for tract closure, we demonstrated a significant decrease in bleeding complications,” Goode said.

Explaining the background to the study, Goode noted: “Increasing numbers of percutaneous transhepatic interventions are being performed worldwide. Recently published results of the British Society of Interventional Radiology Biliary Drainage and Stent Registry showed very high mortality and haemorrhage rates.”

The researchers conducted a retrospective analysis of all patients undergoing percutaneous transhepatic cholangiography and biliary stent insertion between October 2010 and June 2011 (n=101) to identify rates of complications and death. They then further analysed results of procedures performed between November 2011 and November 2012 after a new dedicated liver tract embolization closure method for percutaneous transhepatic cholangiography and biliary stent insertion was initiated (n=119).

Goode and colleagues found that the vast majority of interventions were done for malignant disease (95%). In the cohort that did not undergo dedicated tract embolization, there was a 12% haemorrhage rate. Dedicated liver tract embolization closure was performed in 119 patients and resulted in a significantly decreased haemorrhage rate of 3% (p=0.03). There was also a significant decrease in post-procedural haemoglobin drop in this cohort (p=0.04).

Goode told Interventional News: “These data provide a significant step forward for percutaneous transhepatic procedures. We have shown that utilising a targeted and expanding gelatin foam pledget (Hunter Biospy Sealing Device, Vascular Solutions) for embolizing and essentially closing the liver tract following percutaneous transhepatic procedures, we can decrease haemorrhagic complications associated with these procedures. This is via decreasing the overall rate of arterial haemorrhage but also the subclinical venous bleeding (from portal vein and hepatic venous branch injuries) leading to decrease in haemoglobin post procedure.

“In our institution we perform all our percutaneous liver work utilising this methodology including percutaneous transhepatic cholangiography and biliary stenting and also portal vein embolization procedures. We hope that these data and liver tract embolization methodology that we have presented will go some way to improving outcomes for percutaneous liver procedures and improving safety and clinical outcomes for patients undergoing these high risk interventions.”

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