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Transhepatic Biliary Interventions
Brian Holly, MD; Ashraf Thabet, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Percutaneous transhepatic cholangiography (PTC): Minimally invasive radiologic technique used to visualize biliary tract anatomy
              • Needle introduced through skin into liver to access biliary tract and inject contrast medium
              • Usually combined with percutaneous intervention
            • Percutaneous transhepatic biliary drainage (PTBD): Placement of drainage catheter into biliary tract
              • External drainage: Percutaneous biliary drain with catheter tip in biliary system
              • Internal/external drainage: Percutaneous biliary drain with catheter tip in bowel

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Findings and Reporting

                        • Alternative Procedures/Therapies

                          POST PROCEDURE

                          • Things to Do

                            • Things to Avoid

                              OUTCOMES

                              • Complications

                                • Expected Outcomes

                                  Selected References

                                  1. Wible BC et al: Ethylene-vinyl alcohol copolymer endobiliary obliteration of hepatic segments in a patient with isolated bile leaks. J Vasc Interv Radiol. 25(11):1821-5, 2014
                                  2. Kim JH et al: Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures. J Vasc Interv Radiol. 22(6):893-9, 2011
                                  3. Thornton RH et al: Catheter-free survival after primary percutaneous stenting of malignant bile duct obstruction. AJR Am J Roentgenol. 197(3):W514-8, 2011
                                  4. Kullman E et al: Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc. 72(5):915-23, 2010
                                  5. Saad WE et al: Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol. 21(6):789-95, 2010
                                  6. Telford JJ et al: A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc. 72(5):907-14, 2010
                                  7. Pomerantz BJ: Biliary tract interventions. Tech Vasc Interv Radiol. 12(2):162-70, 2009
                                  8. Brown KT et al: Management of malignant biliary obstruction. Tech Vasc Interv Radiol. 11(1):43-50, 2008
                                  9. Covey AM et al: Percutaneous transhepatic biliary drainage. Tech Vasc Interv Radiol. 11(1):14-20, 2008
                                  10. Saad WE et al: Management of bleeding after percutaneous transhepatic cholangiography or transhepatic biliary drain placement. Tech Vasc Interv Radiol. 11(1):60-71, 2008
                                  11. Saad WE: Percutaneous management of postoperative anastomotic biliary strictures. Tech Vasc Interv Radiol. 11(2):143-53, 2008
                                  12. Saad WE: Transhepatic techniques for accessing the biliary tract. Tech Vasc Interv Radiol. 11(1):21-42, 2008
                                  13. Calvo MM et al: The rendezvous technique for the treatment of choledocholithiasis. Gastrointest Endosc. 54(4):511-3, 2001
                                  14. Gazelle GS et al: Cholangiographic segmental anatomy of the liver. Radiographics. 14(5):1005-13, 1994
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Preprocedure

                                      • Procedure

                                        • Outcomes

                                          TERMINOLOGY

                                          • Definitions

                                            • Percutaneous transhepatic cholangiography (PTC): Minimally invasive radiologic technique used to visualize biliary tract anatomy
                                              • Needle introduced through skin into liver to access biliary tract and inject contrast medium
                                              • Usually combined with percutaneous intervention
                                            • Percutaneous transhepatic biliary drainage (PTBD): Placement of drainage catheter into biliary tract
                                              • External drainage: Percutaneous biliary drain with catheter tip in biliary system
                                              • Internal/external drainage: Percutaneous biliary drain with catheter tip in bowel

                                          PREPROCEDURE

                                          • Indications

                                            • Contraindications

                                              • Preprocedure Imaging

                                                • Getting Started

                                                  PROCEDURE

                                                  • Patient Position/Location

                                                    • Procedure Steps

                                                      • Findings and Reporting

                                                        • Alternative Procedures/Therapies

                                                          POST PROCEDURE

                                                          • Things to Do

                                                            • Things to Avoid

                                                              OUTCOMES

                                                              • Complications

                                                                • Expected Outcomes

                                                                  Selected References

                                                                  1. Wible BC et al: Ethylene-vinyl alcohol copolymer endobiliary obliteration of hepatic segments in a patient with isolated bile leaks. J Vasc Interv Radiol. 25(11):1821-5, 2014
                                                                  2. Kim JH et al: Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures. J Vasc Interv Radiol. 22(6):893-9, 2011
                                                                  3. Thornton RH et al: Catheter-free survival after primary percutaneous stenting of malignant bile duct obstruction. AJR Am J Roentgenol. 197(3):W514-8, 2011
                                                                  4. Kullman E et al: Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study. Gastrointest Endosc. 72(5):915-23, 2010
                                                                  5. Saad WE et al: Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol. 21(6):789-95, 2010
                                                                  6. Telford JJ et al: A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc. 72(5):907-14, 2010
                                                                  7. Pomerantz BJ: Biliary tract interventions. Tech Vasc Interv Radiol. 12(2):162-70, 2009
                                                                  8. Brown KT et al: Management of malignant biliary obstruction. Tech Vasc Interv Radiol. 11(1):43-50, 2008
                                                                  9. Covey AM et al: Percutaneous transhepatic biliary drainage. Tech Vasc Interv Radiol. 11(1):14-20, 2008
                                                                  10. Saad WE et al: Management of bleeding after percutaneous transhepatic cholangiography or transhepatic biliary drain placement. Tech Vasc Interv Radiol. 11(1):60-71, 2008
                                                                  11. Saad WE: Percutaneous management of postoperative anastomotic biliary strictures. Tech Vasc Interv Radiol. 11(2):143-53, 2008
                                                                  12. Saad WE: Transhepatic techniques for accessing the biliary tract. Tech Vasc Interv Radiol. 11(1):21-42, 2008
                                                                  13. Calvo MM et al: The rendezvous technique for the treatment of choledocholithiasis. Gastrointest Endosc. 54(4):511-3, 2001
                                                                  14. Gazelle GS et al: Cholangiographic segmental anatomy of the liver. Radiographics. 14(5):1005-13, 1994