Arterioportal fistula with hepatic artery pseudoaneurysm: A rare complication - Video

Hepatic arterial injury can be seen in approximately 1.3-8% of percutaneous transhepatic biliary drainage manifesting as active extravasation, arteriocholedochal fistula, pseudoaneurysm, or arterioportal shunt. Endovascular embolization in such cases is usually the preferred modality of management while surgery is indicated for fistula recurrence or embolization failure.

The article is covered in Case Reports in Clinical Radiology published by Scientific Scholar and it describes a rare complication of percutaneous transhepatic biliary drainage in a 51-year-old female with recurrent hilar cholangiocarcinoma.

The authors present the case of a patient who presented with blood-mixed peri catheter leak of bile, 1 month after placement of a 10F ring biliary internal-external drainage catheter through the left-sided biliary radical. Colour Doppler and triphasic computed tomography angiography revealed a pseudoaneurysm arising from segment 3rd branch of the left hepatic artery and an arterioportal fistula immediately distal to the pseudoaneurysm. Endovascular coil embolization of the hepatic artery proximal to the pseudoaneurysm was done which resulted in occlusion of the pseudoaneurysm and fistula as well as clinical improvement in the symptoms.

Keeping this report in mind, the authors concluded that the persistence of sanguineous output though the biliary drainage catheter should alert the radiologists toward a possibility of arterial injury. however, other clinical features include systemic hypotension, perihepatic hematoma, hematemesis, or melena.

Reference:

Bhardwaj V, Verma A, Singh PK, Kumar I. Arterioportal fistula with hepatic artery pseudoaneurysm: A rare complication of percutaneous transhepatic biliary drainage. Case Rep Clin Radiol 2023;1:51-4.