Biliary-Caval Fistula following Y90 Radioembolization

Abstract

The safety of radioembolization with yttrium-90 (⁹⁰Y) is well documented and major complications are rare. Previous studies have demonstrated that biliary complications following ⁹⁰Y, including bile duct injury and hepatic abscess formation, occur at an increased rate in patients who have had prior biliary surgery and interventions. This article reviews a case of a patient who developed recurrent cholangitis and sepsis as well as a biliary-caval fistula following radioembolization. Additionally, we review current data regarding biliary complications following radioembolization in patients with prior biliary intervention.

Keywords

radioembolization - ⁹⁰Y - liver-directed therapy - cholangitis - biliary infection - interventional radiology

Publikationsverlauf

Artikel online veröffentlicht:
07. Oktober 2021

• References

• 1 Covey AM, Hussain SM. Liver-directed therapy for hepatocellular carcinoma: An overview of techniques, outcomes, and posttreatment imaging findings. AJR Am J Roentgenol 2017; 209 (01) 67-76
• 2 Mahnken AH. Current status of transarterial radioembolization. World J Radiol 2016; 8 (05) 449-459
• 3 Salem R, Lewandowski RJ, Mulcahy MF. et al. Radioembolization for hepatocellular carcinoma using yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology 2010; 138 (01) 52-64
• 4 Gray B, Van Hazel G, Hope M. et al. Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 2001; 12 (12) 1711-1720
• 5 Rhee TK, Lewandowski RJ, Liu DM. et al. 90Y radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg 2008; 247 (06) 1029-1035
• 6 Kennedy AS, Dezarn WA, McNeillie P. et al. Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol 2008; 31 (03) 271-279
• 7 Kennedy AS, Coldwell D, Nutting C. et al. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 2006; 65 (02) 412-425
• 8 Murthy R, Xiong H, Nunez R. et al. Yttrium 90 resin microspheres for the treatment of unresectable colorectal hepatic metastases after failure of multiple chemotherapy regimens: preliminary results. J Vasc Interv Radiol 2005; 16 (07) 937-945
• 9 Riaz A, Lewandowski RJ, Kulik LM. et al. Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 2009; 20 (09) 1121-1130 , quiz 1131
• 10 Riaz A, Awais R, Salem R. Side effects of yttrium-90 radioembolization. Front Oncol 2014; 4: 198
• 11 Atassi B, Bangash AK, Lewandowski RJ. et al. Biliary sequelae following radioembolization with yttrium-90 microspheres. J Vasc Interv Radiol 2008; 19 (05) 691-697
• 12 Salem R, Lewandowski RJ, Atassi B. et al. Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival. J Vasc Interv Radiol 2005; 16 (12) 1627-1639
• 13 Yu JS, Kim KW, Jeong MG, Lee DH, Park MS, Yoon SW. Predisposing factors of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic malignancy. Cardiovasc Intervent Radiol 2002; 25 (04) 270-274
• 14 Woo S, Chung JW, Hur S. et al. Liver abscess after transarterial chemoembolization in patients with bilioenteric anastomosis: frequency and risk factors. AJR Am J Roentgenol 2013; 200 (06) 1370-1377
• 15 Kim W, Clark TW, Baum RA, Soulen MC. Risk factors for liver abscess formation after hepatic chemoembolization. J Vasc Interv Radiol 2001; 12 (08) 965-968
• 16 Song SY, Chung JW, Han JK. et al. Liver abscess after transcatheter oily chemoembolization for hepatic tumors: incidence, predisposing factors, and clinical outcome. J Vasc Interv Radiol 2001; 12 (03) 313-320
• 17 Sun Z, Li G, Ai X. et al. Hepatic and biliary damage after transarterial chemoembolization for malignant hepatic tumors: incidence, diagnosis, treatment, outcome and mechanism. Crit Rev Oncol Hematol 2011; 79 (02) 164-174
• 18 Zhang B, Guo Y, Wu K, Shan H. Intrahepatic biloma following transcatheter arterial chemoembolization for hepatocellular carcinoma: incidence, imaging features and management. Mol Clin Oncol 2017; 6 (06) 937-943
• 19 Sivaraj SM, Vimalraj V, Saravanaboopathy P. et al. Is bactibilia a predictor of poor outcome of pancreaticoduodenectomy?. Hepatobiliary Pancreat Dis Int 2010; 9 (01) 65-68
• 20 Cholapranee A, van Houten D, Deitrick G. et al. Risk of liver abscess formation in patients with prior biliary intervention following yttrium-90 radioembolization. Cardiovasc Intervent Radiol 2015; 38 (02) 397-400
• 21 Parikh RS, Abousoud O, Hunt S. et al. Infection rates following hepatic embolotherapy in patients with prior biliary interventions: comparison of single-drug moxifloxacin and multidrug antibiotic prophylaxis. J Vasc Interv Radiol 2021; 32 (05) 739-744
• 22 Devulapalli KK, Fidelman N, Soulen MC. et al. ⁹⁰Y radioembolization for hepatic malignancy in patients with previous biliary intervention: multicenter analysis of hepatobiliary infections. Radiology 2018; 288 (03) 774-781
• 23 Mascarenhas NB, Mulcahy MF, Lewandowski RJ, Salem R, Ryu RK. Hepatic abscess after yttrium-90 radioembolization for islet-cell tumor hepatic metastasis. Cardiovasc Intervent Radiol 2010; 33 (03) 650-653
• 24 Mascarenhas N, Ryu RK, Salem R. Hepatic radioembolization complicated by abscess. Semin Intervent Radiol 2011; 28 (02) 222-225
• 25 Fatemi N, Lee A, Kessler J, Park J. Evaluating the safety of radioembolization with yttrium 90 microspheres in patients with prior biliary intervention. J Vasc Interv Radiol 2017; 28 (02) S216-S217
• 26 Geschwind JF, Kaushik S, Ramsey DE, Choti MA, Fishman EK, Kobeiter H. Influence of a new prophylactic antibiotic therapy on the incidence of liver abscesses after chemoembolization treatment of liver tumors. J Vasc Interv Radiol 2002; 13 (11) 1163-1166