Korean J Radiol.  2013 Oct;14(5):801-804. 10.3348/kjr.2013.14.5.801.

Use of Amplatzer Vascular Plug to Treat a Biliary Cutaneous Fistula

• Ierardi AM
• Fontana F
• Mangini M
• Piacentino F
• Cocozza E
• Frankowska E
• Floridi C
• Carrafiello G

• KMID: 1711437
• DOI: http://doi.org/10.3348/kjr.2013.14.5.801

Abstract

Several substances have been used in an attempt to sclerose biliary ducts associated with persistent biliary-cutaneous fistula (BCF). The AMPLATZER Vascular Plug (AVP; AGA Medical, USA) system is a recently developed endovascular occlusion device, introduced as an alternative to permanent embolic materials (metallic coils or acrylic glue), in the occlusion of large and medium-calibre arteries and veins. We report a successful use of the AVP to embolize BCF, developed after the removal of an internal-external biliary drainage.

Keyword

Biliary cutaneous fistula; Vascular Plug; Biliary drainage complications

MeSH Terms

Aged
Biliary Fistula/radiography/*therapy
Cholangiography
Cutaneous Fistula/radiography/*therapy
Embolization, Therapeutic/*instrumentation
Female
Humans
*Septal Occluder Device

Figure

• 

  Fig. 1 Cholangiogram, fistulography and embolization. A. Cholangiogram revealed persistence of BCF and of biliary leakage and correct functioning of stent; white arrow indicates thick surgical drainage; black arrow indicates biliary stent. B, C. Fistulography performed using cutaneous approach revealed persistent BCF (arrow) (B); cholangiogram performed after AVP (arrow) release, revealing the complete exclusion of the fistula (C). BCF = biliary-cutaneous fistula, AVP = AMPLATZER Vascular plug.

Reference

1. Park JH, Oh JH, Yoon Y, Hong SH, Park SJ. Acetic acid sclerotherapy for treatment of a biliary leak from an isolated bile duct after hepatic surgery. J Vasc Interv Radiol. 2005; 16:885–888.

2. Vu DN, Strub WM, Nguyen PM. Biliary duct ablation with N-butyl cyanoacrylate. J Vasc Interv Radiol. 2006; 17:63–69.

3. Eicher CA, Adelson AB, Himmelberg JA, Chintalapudi U. Laser ablation of a biliary duct for treatment of a persistent biliary-cutaneous fistula. J Vasc Interv Radiol. 2008; 19(2 Pt 1):294–297.

4. Carrafiello G, Ierardi AM, Piacentino F, Cardim LN. Percutaneous transhepatic embolization of biliary leakage with N-butyl cyanoacrylate. Indian J Radiol Imaging. 2012; 22:19–22.

5. Wang W, Li H, Tam MD, Zhou D, Wang DX, Spain J. The amplatzer vascular plug: a review of the device and its clinical applications. Cardiovasc Intervent Radiol. 2012; 35:725–740.

6. Wang JK, Tsai SK, Wu MH, Lin MT, Lue HC. Short- and intermediate-term results of transcatheter closure of atrial septal defect with the Amplatzer Septal Occluder. Am Heart J. 2004; 148:511–517.

7. Lee SA, Lee YS, Lee KS, Jeon GS. Congenital intrahepatic portosystemic venous shunt and liver mass in a child patient: successful endovascular treatment with an amplatzer vascular plug (AVP). Korean J Radiol. 2010; 11:583–586.

8. Lee YJ, Shin BS, Lee IH, Ohm JY, Lee BS, Ahn M, et al. Intrahepatic portosystemic venous shunt: successful embolization using the Amplatzer Vascular Plug II. Korean J Radiol. 2012; 13:827–831.

9. Ianniello A, Carrafiello G, Nicotera P, Vaghi A, Cazzulani A. Endovascular treatment of a ruptured pulmonary artery aneurysm in a patient with Behçet’s disease using the Amplatzer Vascular Plug 4. Korean J Radiol. 2013; 14:283–286.

10. Fruchter O, Bruckheimer E, Raviv Y, Rosengarten D, Saute M, Kramer MR. Endobronchial closure of bronchopleural fistulas with Amplatzer vascular plug. Eur J Cardiothorac Surg. 2012; 41:46–49.

11. Koo JH, Park KB, Choo SW, Kim K, Do YS. Embolization of postsurgical esophagopleural fistula with AMPLATZER vascular plug, coils, and Histoacryl glue. J Vasc Interv Radiol. 2010; 21:1905–1910.

12. Schild HH, Meyer C, Möhlenbroch M, Mueller SC, Simon B, Kuhl CK. Transrenal ureter occlusion with an Amplatzer vascular plug. J Vasc Interv Radiol. 2009; 20:1390–1392.

13. Dionello R, Warakaulle D, Liong WC. A novel use of the AMPLATZER vascular plug: preventing bile leak following inadvertent subcapsular deployment of a biliary stent. Cardiovasc Intervent Radiol. 2010; 33:213–214.

14. Doshi T, Mojtahedi A, Goswami GK, Andrews RT, Godke B, Valji K. Persistent cystic duct stump leak managed with hydrocoil embolization. Cardiovasc Intervent Radiol. 2009; 32:394–396.

15. Pellerin O, Caruba T, Kandounakis Y, Novelli L, Pineau J, Prognon P, et al. Embolization of the internal iliac artery: cost-effectiveness of two different techniques. Cardiovasc Intervent Radiol. 2008; 31:1088–1093.