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Acute and delayed bleeding requiring embolization after image-guided liver biopsy in patients with cancer

  • Alan A. Sag
    Correspondence
    Corresponding author. Koç University School of Medicine, Rumelifeneri Yolu, Sariyer 34450, Istanbul, Turkey. Tel.: +90-212-338-1176; fax: +90-212-338-1165.
    Affiliations
    Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA

    Division of Interventional Radiology, Department of Radiology, Koç University School of Medicine, Istanbul, Turkey
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  • Lynn A. Brody
    Affiliations
    Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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  • Majid Maybody
    Affiliations
    Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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  • Joseph P. Erinjeri
    Affiliations
    Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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  • Xiaodong Wang
    Affiliations
    Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA

    Department of Interventional Radiology, Peking University Cancer Hospital and Institute and Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing, China
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  • Thomas Wimmer
    Affiliations
    Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA

    Department of Radiology, Medical University of Graz, Graz, Austria
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  • Mikhail Silk
    Affiliations
    Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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  • Elena N. Petre
    Affiliations
    Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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  • Stephen B. Solomon
    Affiliations
    Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Published:November 13, 2015DOI:https://doi.org/10.1016/j.clinimag.2015.11.004

      Abstract

      Purpose

      To report incidence of acute versus delayed presentations of bleeding requiring embolization after focal liver biopsy, in correlation with angiographic findings and treatment success rates. The available literature will be reviewed as well.

      Materials and methods

      Health Insurance Portability and Accountability Act-compliant institutional review board approved retrospective review of 2180 consecutive patients undergoing 2335 targeted liver biopsies at a tertiary-care cancer center. Hepatic arterial embolization episodes within 30 days from biopsy were identified via radiology PACS. Electronic medical record review was performed for indication of embolization and postembolization clinical course.

      Results

      The incidence of postbiopsy bleeding requiring embolization was 0.5% (12/2335 biopsies). In those with bleeding, 1/12 (8%) had no hepatic arterial findings at angiography. Angiographic hepatic arterial findings resolved after embolization in 11/11 patients (100% technical success). Bleeding ceased after embolization in 10/12 patients (83% clinical success). Complications were seen in 2/12 (17%) patients: cholecystitis and hepatic infarct, respectively. Delayed presentation of bleeding (defined as >24 h postbiopsy) occurred in 5/12 (42%) patients; the longest latency was 12 days.

      Conclusion

      The overall incidence of bleeding requiring embolization in our population was 0.5%. This complication rate compares favorably to the 0–4.2% (median: 0.29%) rate quoted in the available, heterogeneous, literature on this topic. Delayed presentation occurred in almost half of patients. Arterial embolization carries excellent technical and clinical success rates.

      Keywords

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