Vascular complications in percutaneous biliary interventions

Abstract

Percutaneous biliary interventions are indicated for both benign or malignant biliary strictures to treat obstructive jaundice and/or biliary leak. Major vascular complications include active bleeding or more frequently pseudoaneurysm formation, bilio-portal, bilio-venous or arterio-biliary fistulae and intra- or peri-hepatic hematoma. Such adverse events can occur during the procedure itself or, more often, several days to weeks after the initial procedure. Major vascular complications frequently manifest with symptoms of hemobilia (jaundice, pain, melena or hemochezia and reduced serum hemoglobin levels), which in some cases lead to life-threatening hemodynamic compromise. Computed tomography angiography is mandatory to diagnose the cause and site of bleeding, while simultaneously depicting the anatomy, in order to plan the treatment. Covered stents, liquid embolic agents and coils are the commonest devices used, depending on the underlying pathology. Although such complications are rare, they are frequently life-threatening, and require prompt treatment. Therefore, interventional radiologists must be proficient in their management. This narrative minireview aims to outline management strategies of the most frequent intra- or post-procedural vascular complications following biliary interventions.

Keywords: Biliary intervention; Percutaneous transhepatic biliary drainage; Biliary stent; Vascular complications; Pseudoaneurysm; Bilio-portal fistula; Bilio-venous fistula; Arterio-biliary fistula; Hemobilia

Core Tip: Vascular complications after percutaneous biliary interventions, though rare, are potentially life-threatening and require prompt diagnosis and management. These may include pseudoaneurysms, vascular fistulas, and hematomas, which can present with hemobilia, pain, or hemodynamic instability. Computed tomography angiography is essential for diagnosis and treatment planning. Common treatments include covered stents, coils, and liquid embolics. This narrative minireview outlines the recognition and management of such complications during or after biliary drainage or stenting.