Tract Embolization after Percutaneous Transhepatic Portal Interventions: A15-Year Single-Center Experience Using a Coil-Gelfoam Sandwich Technique

Purpose: The main purpose of this article is to determine the effectiveness of tract embolization (TE) after transhepatic portal access interventions in preventing post-procedural bleeding complications.

Materials and Methods: A retrospective review of 132 patients that underwent transhepatic portal interventions between 2003 and 2018 was performed. Patient characteristics, medications, laboratory values, procedure details, and pre- and post-procedural imaging were reviewed. TE was performed using Gelfoam only, embolization coils only, or a coil-Gelfoam sandwich technique. Technical success was defined as achieving hemostasis at the skin entry site at the end of the procedure. Clinical success was defined as the absence of bleeding following TE.

Results: Median age was 45 years (range: 3 months–76 years). Average sheath size used was 5.3 Fr (range: 4–10). Coil-Gelfoam sandwich technique was used in 111 patients (84%), Gelfoam pledgets only in 17 patients (13%), and coil only in 4 patients (3%). There was no difference in coagulation parameters or use of antiplatelet/anticoagulation medication between the three groups. Technical success was 100%. Two bleeding complications occurred within 24 hours, one in the coil only group, and one in the coil-Gelfoam sandwich group. Neither complication occurred in patients with low platelets or high international normalized ratio or on antiplatelet/anticoagulant medications.

Conclusion: TE after percutaneous transhepatic portal interventions is effective in preventing post-procedural bleeding complications, particularly using a coil-Gelfoam sandwich embolization technique.

No conflict of interest has been declared by the author(s).