Pyogenic abscess after Hepatic artery embolization: A rare but potentially lethal complication Journal Article

Authors: Mezhir, J. J.; Fong, Y.; Fleischer, D.; Seo, S. K.; D'amico, F.; Petre, E.; Covey, A. M.; Getrajdman, G. I.; Thornton, R. H.; Solomon, S. B.; Jarnagin, W. R.; Brown, K. T.
Article Title: Pyogenic abscess after Hepatic artery embolization: A rare but potentially lethal complication
Abstract: Purpose Hepatic artery embolization (HAE) is used commonly to treat liver tumors or hemorrhage. Infectious complications are rare but carry high rates of morbidity and mortality. Identification of clinical factors associated with postembolization abscess may improve management and outcome. Materials and Methods Clinical and pathologic variables of patients treated with HAE were collected and analyzed to determine the etiology, incidence, and outcome of pyogenic hepatic abscess. Results From January 1998 to January 2010, 971 patients underwent 2,045 HAE procedures. Fourteen patients developed a pyogenic hepatic abscess after embolization, for an overall rate of 1.4%. Thirty-four patients (4%) had a history of bilioenteric anastomosis (BEA) and 21 patients (2%) lacked a competent sphincter of Oddi because of the presence of a biliary stent (n = 19) or a previous sphincterotomy (n = 2). Eleven of the 34 patients with a BEA (33%) and two of 21 patients with an incompetent sphincter (10%) developed abscesses, in contrast to only one abscess (0.05%) among the 916 patients with apparently normal sphincters (0.1%; odds ratio, 437.6; 95% CI, 54.23,533; P < .0001). Gram-negative and Gram-positive aerobes were the most common bacteria isolated after drainage. Percutaneous drainage was the initial management strategy in all patients; two patients (14%) required subsequent surgical drainage and hepatectomy, and three (21%) died. Conclusions Pyogenic hepatic abscess is rare after HAE. A history of BEA or an incompetent sphincter of Oddi caused by a biliary stent or previous sphincterotomy substantially increases the likelihood of this highly morbid and potentially fatal complication. © 2011 SIR.
Keywords: hepatocellular carcinoma; neuroendocrine tumor; abbreviations; bea; bilioenteric anastomosis; hae; hcc; hepatic arterial embolization; net
Journal Title: Journal of Vascular and Interventional Radiology
Volume: 22
Issue: 2
ISSN: 1051-0443
Publisher: Elsevier Science, Inc.  
Date Published: 2011-02-01
Start Page: 177
End Page: 182
Language: English
DOI: 10.1016/j.jvir.2010.10.014
PROVIDER: scopus
PUBMED: 21195630
PMCID: PMC5000549
Notes: --- - "Export Date: 4 March 2011" - "CODEN: JVIRE" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Susan Seo
    72 Seo
  2. James John Mezhir
    13 Mezhir
  3. Anne Covey
    133 Covey
  4. William R Jarnagin
    642 Jarnagin
  5. Yuman Fong
    772 Fong
  6. Karen T Brown
    171 Brown
  7. Stephen Solomon
    302 Solomon
  8. Elena Nadia Petre
    58 Petre