Radiofrequency Ablation to Control Bleeding from a Percutaneous Intrahepatic Puncture Tract of a Large Diameter Portal V
- PDF / 685,688 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 45 Downloads / 145 Views
LETTER TO THE EDITOR
Radiofrequency Ablation to Control Bleeding from a Percutaneous Intrahepatic Puncture Tract of a Large Diameter Portal Vein: A Simple and Rapid Solution to a Potentially Life-Threatening Bleeding Mathilde Vermersch1 • Rafael Duran1 • Naik Vietti Violi1 • Nicolas Villard1 Georgia Tsoumakidou1 • Alban Denys1 • Arnaud Hocquelet1
•
Received: 18 April 2020 / Accepted: 8 July 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Dear Editor, Taking a case as an example, we would like to present here a diverted use of the radiofrequency ablation to stop a hepatic bleeding. Percutaneous puncture of an intrahepatic portal vein is currently used in order to treat portal vein stenosis/thrombosis and portal hypertension-related bleeding. After these procedures, significant bleeding can occur through the puncture tract. Consequently, embolization of trans-parenchymal puncture tract is recommended. However, even if intrahepatic access tract is embolized, severe bleeding is sometimes observed [1–3]. Literature focusing on iatrogenic portal vein bleeding is scarce without guidelines of care [4]. We report a severe portal bleeding after a portal branch access successfully treated using radiofrequency ablation of the bleeding tract. A 66-year-old female with esogastric varices due to portal hypertension was referred to our institution for hematemesis. Endoscopic treatment was attempted, complicated by massive hemorrhage. Transjugular intrahepatic portocaval shunt was contraindicated because of pulmonary arterial hypertension, so a percutaneous transhepatic varices embolization was performed with a right transhepatic portal 8-French access sheath closed by one coil. Later, a multiphasic contrast-enhanced CT scan, performed because of hemodynamic instability, showed a venous active bleeding at the hepatic puncture site and coil migration (Fig. 1). Due to hemodynamic instability, a new transhepatic portal access was not appropriated. Emergent
& Mathilde Vermersch [email protected] 1
Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
Fig. 1 Coronal (a) and axial (b) reconstruction of CT scan at portal venous phase. At the center of the image, embolization material is visualized into varices with metallic artefacts. Important hemoperitoneum is observed with active bleeding from transhepatic puncture tract (arrow). Coil used for embolization of transhepatic puncture tract migrated in the peritoneum cavity (arrowhead)
123
Vermersch et al.: Radiofrequency Ablation to Control Bleeding from a Percutaneous…
Fig. 2 Ultrasound with color Doppler showing active bleeding (arrowhead) from portal vein through the transhepatic puncture tract up to peritoneum cavity (a). Under ultrasound control, cluster (arrow)
insertion along transhepatic puncture tract (b) and progressive thermal ablation (c, d). Completion ultrasound with Doppler confirmed the absence of active bleeding (e,
Data Loading...
