Development of the safe and reliable puncture tract embolization technique following percutaneous transhepatic interventions

Abstract

Bleeding from the puncture site is a serious complication that can occur during percutaneous transhepatic interventions. We experienced a patient showing serious postoperative bleeding from the puncture site. Thus, we have reviewed and improved the procedure for puncture tract embolization. According to the conventional method, a paste-like embolic gel created from gelatin sponges and contrast agents were injected into the puncture tract through a guiding sheath for angiography. There were instances, however, where the procedure was not stable, such as the sheath unexpectedly coming out too early or embolization agent leaking into the portal vein, resulting in inadequate status of the embolization agent. Thus, we introduced a parallel insertion of a guide wire of 0.035 inch and micorcatheter into the sheath; initially, a metallic coil was placed within the tract via the catheter, followed by the injection of embolization agent. Leaving the guidewire within the catheter stabilized the behavior of the sheath. Moreover, the use of metallic coils minimized the outflow of embolization agents into the portal vein, allowing for stable filling of the tract with embolization agents, and enhancing its occlusive properties. The synergistic effect of metabolic coils and a paste-like embolic gels resulted in a robust embolization. Thus, this method has been evaluated as a safe and reliable tract embolization technique.