Case study

Courtesy of Dr. Abhishek Kumar I Rutgers New Jersey Medical School

68-year-old man s/p open cholecystectomy complicated by bile duct injury and bile leak presented for percutaneous transhepatic biliary drainage. A week following right internal/external biliary drain placement, the patient returned a week later with blood in the drainage bag.

Right femoral arterial access was obtained and a 5 F sheath was placed. A 5 F Sos catheter was used to select the celiac artery and an angiogram was performed. Angiography demonstrated a pseudoaneurysm of a right hepatic artery branch adjacent to the biliary drain (arrow). A 2.4 F microcatheter and 0.014” wire were then used to catheterize the vessel supplying the pseudoaneurysm. The vessel was embolized with 0.2 cc of Obsidio Embolic using a slow injection rate to allow the embolic to flow distally into the pseudoaneurysm. Post-imaging depicts the Obsidio Embolic cast. A completion celiac angiogram demonstrated complete embolization of the hepatic artery pseudoaneurysm.

The patient was discharged home 4 hours following the procedure with no recurrence of bleeding.