Hepatic Arterial Injuries in 3110 Patients Following Percutaneous Transhepatic Biliary Drainage

To evaluate the frequency of hepatic arterial injury in 3110 patients who had undergone percutaneous transhepatic biliary drainage (PTBD) and assess the risk factors for hepatic arterial injury and the treatment outcome after transcatheter arterial embolization. A total of 3110 patients who underwent 3780 PTBDs between January 2003 and December 2008 were retrospectively assessed. This study was approved by the Institutional Review Board. The incidence of hepatic arterial injury was determined and the risk factors associated with it were analyzed by using univariate and multiple logistic regression analyses. Hepatic angiography was performed to identify the bleeding focus, followed by transcatheter arterial embolization. Hepatic arterial injuries occurred after 72 (1.9%) of 3780 PTBDs. When adjusted for benign disease, perihepatic ascites, platelet count of 50,000/mm(3) or less, international normalization ratio of 1.5 or greater, and left-sided puncture, multiple logistic regression analysis showed that left-sided PTBD (odds ratio, 2.017; 95% confidence interval: 1.257, 3.236; P = .004) was the only independent risk factor associated with hepatic arterial injury. The technical and clinical success rates of transcatheter arterial embolization were 100% and 95.8%, respectively. Minor complications were observed in 58 (80.6%) patients, 55 (76.4%) of whom had hepatic ischemia and three (4.2%) of whom had focal hepatic infarction. No major complication was observed in any patient. Hepatic arterial injury is a relatively rare complication of PTBD. Because left-sided PTBD is the only independent risk factor associated with hepatic arterial injury, right-sided PTBD is preferable unless technical difficulty or secondary intervention necessitates left-sided PTBD. Moreover, transcatheter arterial embolization is a safe and effective method for treating hepatic arterial injury following PTBD.