Percutaneous transhepatic arterial access for coil embolization of hepatic artery infusion pump-associated bleeding
Abstract Background Hepatic artery infusion pump (HAIP) chemotherapy is a locoregional treatment for intrahepatic malignancies. HAIPs are surgically implanted, and the catheter tip is typically inserted into a ligated gastroduodenal artery stump. Potential complications at the catheter insertion sit...
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SpringerOpen
2025-01-01
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| Series: | CVIR Endovascular |
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| Online Access: | https://doi.org/10.1186/s42155-024-00515-w |
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| author | Anuj K. Dutta Vishal Shankar Ernesto G. Santos Brett Marinelli Erica S. Alexander Vlasios S. Sotirchos Ken Zhao |
| author_facet | Anuj K. Dutta Vishal Shankar Ernesto G. Santos Brett Marinelli Erica S. Alexander Vlasios S. Sotirchos Ken Zhao |
| author_sort | Anuj K. Dutta |
| collection | DOAJ |
| description | Abstract Background Hepatic artery infusion pump (HAIP) chemotherapy is a locoregional treatment for intrahepatic malignancies. HAIPs are surgically implanted, and the catheter tip is typically inserted into a ligated gastroduodenal artery stump. Potential complications at the catheter insertion site include dehiscence, pseudoaneurysm or extravasation, and adjacent hepatic arterial stenosis and thrombosis. Bleeding complications can be treated with stent-graft placement or coil embolization across the injury site, typically with standard antegrade arterial approach into the hepatic arterial system by transfemoral or transradial access. However, in cases where an antegrade approach is not possible, alternative methods are necessary. Case presentation A patient presented with an enlarging hematoma due to bleeding at the gastroduodenal artery HAIP catheter insertion site. Emergent angiography revealed concomitant common hepatic artery occlusion and retrograde perfusion of the GDA via tortuous, diminutive hepatic collaterals which precluded standard antegrade approach. Collateral inflow from the dorsal pancreatic artery was utilized to opacify the right hepatic artery. The segment 5 hepatic artery was percutaneously accessed under fluoroscopic guidance, and microcoils were deployed both proximal and distal to origin of the gastroduodenal artery. The patient remained stable throughout the postoperative period and was discharged after an otherwise uneventful admission. Follow-up computed tomography demonstrated resolution of the hematoma and no bleeding or biliary complication from transhepatic access. Conclusions This report highlights the safety and efficacy of percutaneous transhepatic arterial access for endovascular management of HAIP associated bleeding at the gastroduodenal artery when standard antegrade interventions cannot be performed. Interventional radiologists caring for patients with HAIPs should be familiar with their potential complications and the range of techniques required for management. |
| format | Article |
| id | doaj-art-a81802cecdbe45678150b67719fbbda1 |
| institution | Kabale University |
| issn | 2520-8934 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj-art-a81802cecdbe45678150b67719fbbda12025-01-12T12:41:21ZengSpringerOpenCVIR Endovascular2520-89342025-01-01811510.1186/s42155-024-00515-wPercutaneous transhepatic arterial access for coil embolization of hepatic artery infusion pump-associated bleedingAnuj K. Dutta0Vishal Shankar1Ernesto G. Santos2Brett Marinelli3Erica S. Alexander4Vlasios S. Sotirchos5Ken Zhao6Albert Einstein College of MedicineAlbert Einstein College of MedicineDepartment of Radiology, Memorial Sloan Kettering Cancer CenterDepartment of Radiology, Memorial Sloan Kettering Cancer CenterDepartment of Radiology, Memorial Sloan Kettering Cancer CenterDepartment of Radiology, Memorial Sloan Kettering Cancer CenterDepartment of Radiology, Memorial Sloan Kettering Cancer CenterAbstract Background Hepatic artery infusion pump (HAIP) chemotherapy is a locoregional treatment for intrahepatic malignancies. HAIPs are surgically implanted, and the catheter tip is typically inserted into a ligated gastroduodenal artery stump. Potential complications at the catheter insertion site include dehiscence, pseudoaneurysm or extravasation, and adjacent hepatic arterial stenosis and thrombosis. Bleeding complications can be treated with stent-graft placement or coil embolization across the injury site, typically with standard antegrade arterial approach into the hepatic arterial system by transfemoral or transradial access. However, in cases where an antegrade approach is not possible, alternative methods are necessary. Case presentation A patient presented with an enlarging hematoma due to bleeding at the gastroduodenal artery HAIP catheter insertion site. Emergent angiography revealed concomitant common hepatic artery occlusion and retrograde perfusion of the GDA via tortuous, diminutive hepatic collaterals which precluded standard antegrade approach. Collateral inflow from the dorsal pancreatic artery was utilized to opacify the right hepatic artery. The segment 5 hepatic artery was percutaneously accessed under fluoroscopic guidance, and microcoils were deployed both proximal and distal to origin of the gastroduodenal artery. The patient remained stable throughout the postoperative period and was discharged after an otherwise uneventful admission. Follow-up computed tomography demonstrated resolution of the hematoma and no bleeding or biliary complication from transhepatic access. Conclusions This report highlights the safety and efficacy of percutaneous transhepatic arterial access for endovascular management of HAIP associated bleeding at the gastroduodenal artery when standard antegrade interventions cannot be performed. Interventional radiologists caring for patients with HAIPs should be familiar with their potential complications and the range of techniques required for management.https://doi.org/10.1186/s42155-024-00515-wHepatic artery infusion pumpTranshepatic arterial accessHepatic arterial bleeding |
| spellingShingle | Anuj K. Dutta Vishal Shankar Ernesto G. Santos Brett Marinelli Erica S. Alexander Vlasios S. Sotirchos Ken Zhao Percutaneous transhepatic arterial access for coil embolization of hepatic artery infusion pump-associated bleeding CVIR Endovascular Hepatic artery infusion pump Transhepatic arterial access Hepatic arterial bleeding |
| title | Percutaneous transhepatic arterial access for coil embolization of hepatic artery infusion pump-associated bleeding |
| title_full | Percutaneous transhepatic arterial access for coil embolization of hepatic artery infusion pump-associated bleeding |
| title_fullStr | Percutaneous transhepatic arterial access for coil embolization of hepatic artery infusion pump-associated bleeding |
| title_full_unstemmed | Percutaneous transhepatic arterial access for coil embolization of hepatic artery infusion pump-associated bleeding |
| title_short | Percutaneous transhepatic arterial access for coil embolization of hepatic artery infusion pump-associated bleeding |
| title_sort | percutaneous transhepatic arterial access for coil embolization of hepatic artery infusion pump associated bleeding |
| topic | Hepatic artery infusion pump Transhepatic arterial access Hepatic arterial bleeding |
| url | https://doi.org/10.1186/s42155-024-00515-w |
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