PREVENTION OF SIGNIFICANT HEMOBILIA DURING PLACEMENT OF TRANSHEPATIC BILIARY DRAINAGE CATHETERS - TECHNIQUE MODIFICATION AND INITIAL RESULTS

PURPOSE: The authors evaluated a technique for the prevention of signi ficant hemobilia during placement of transhepatic biliary drainage cat heters (TBDCs). PATIENTS AND METHODS: Twenty patients with strictures were randomized to two groups. In the control group, the biliary tree was accessed with an Accustick system and a TBDC was placed routinely. In the experimental group, following initial access, a rotating hemos tatic valve was attached and the outer sheath was pulled back over the wire while contrast material was injected. If a major vascular struct ure was encountered, the tract was not used for TBDC placement. Howeve r, the outer sheath was re-advanced and used to opacify the ducts. Thi s facilitated separate access. Once access was achieved without traver sing a major vascular structure, a TBDC was placed, and the Accustick system was removed. If a portal vein or hepatic vein branch was traver sed, no additional maneuvers were performed. However, if a branch of t he hepatic artery had been traversed, the tract and biliary-arterial f istula were embolized with gelatin sponge pledgets. Both groups were e valuated for hemobilia for 6 weeks. RESULTS: In the control group, the re were three cases of significant hemobilia; two were mild, one was s evere. In the experimental group, the tract communicated with a major vascular structure in three patients. In these patients, a second acce ss was used for TBDC placement. None of the patients in the experiment al group experienced significant hemobilia. CONCLUSION: Visualization prevents the usage of tracts that communicate with large vascular stru ctures. Initial results indicate that this reduces the frequency of si gnificant hemobilia when TBDCs are placed.