Large bore transhepatic tract dilatation in pigs: results and implicationsfor human procedures

Large bore transhepatic tracts were created in six anesthetised pigs. A per ipheral tract (entering the gall-bladder bed) and a central tract were crea ted in each pig. After balloon dilatation to 30 F and passage of a 30 F inn er diameter sheath, bleeding was monitored with the sheath in place and aft er sheath removal. Blood loss was quantified and tracts were examined micro scopically. Peripheral tracts were shorter than central tracts (mean 1.9 ve rsus 3.6 cm). Bleeding occurred more frequently and to a greater degree fro m central tracts. Injury to small arteries and veins was identified microsc opically in two tracts that bled heavily. Although significant bleeding, or lack thereof after dilatation of large transhepatic tracts, was variable, recommendations for large tract dilatation include: selection of a peripher al tract route, use of a working sheath with an outside diameter not exceed ing that of the inflated balloon, particular care to avoid loss of access a nd not removing sheaths prematurely.