TREATMENT OF HEMOBILIA WITH SELECTIVE HEPATIC-ARTERY EMBOLIZATION

PURPOSE: To evaluate retrospectively the results of selective transcat heter embolization in the treatment of hemobilia. PATIENTS AND METHODS : Twelve patients with hemobilia (mean age, 43 years) underwent embolo therapy, Causes of hepatic vascular injury were iatrogenic trauma, blu nt external trauma, septic emboli, and lupus vasculitis, A 5-F cobra c atheter or a 5-F nontapered Simmons shaped catheter passed over a hydr ophilic guide wire, or a Tracker 18 catheter forming a coaxial system was used. Embolic agents included gelatin sponge or polyvinyl alcohol fragments used alone or with coils. RESULTS: Hepatic artery pseudoaneu rysms were found in 10 patients, ruptured hepatic artery aneurysm was found in one, and arterioportal fistula was found in two (with pseudoa neurysm in one). Bleeding was immediately controlled in 11 of 12 patie nts after embolization; one patient rebled and underwent surgery, Two patients underwent repeat embolization (2 weeks and 2 months later), T wo patients died, one of biliary sepsis and liver insufficiency 24 hou rs after embolization and the other of gangrenous cholecystitis. CONCL USION: Transcatheter embolization is an effective treatment of hemobil ia. It allows control of bleeding and identification of the origin of the hemorrhage.