Bile Duct Injury after Transcatheter Arterial Chemoembolization: Risk Factors and Clinical Implications.

Objective: The current study aims to investigate the risk factors and clinical implications of bile duct injury after performing transcatheter arterial chemoembolization (TACE) for the treatment of patients with hepatic malignancy.

Methods: A total of 2340 patients with hepatic malignancies underwent 5656 TACE procedures without any radiographic evidence of biliary abnormalities pre-TACE. Of these, 40 patients developed bile duct injuries 3 weeks to 3 months after TACE.

Results: TACE-induced bile duct injuries occurred in 30 out of 348 patients with liver metastatic tumors (8.6%) and in 10 out of 1992 patients with hepatocellular carcinoma (HCC) (0.5%). Bile duct injuries, including focal (n = 12) and multiple intrahepatic bile duct dilatation (n = 16), along with cystic lesions or bilomas (n = 12), were identified during follow-up post-TACE imaging. In addition, 6 patients with multiple bile duct injuries presented mild jaundice, and 8 patients with large biloma showed associated serious bacterial infections. The remaining 26 patients were asymptomatic. Biliary injury-related mortality occurred in 4 patients (10%).

Conclusions: Knowledge of TACE-induced bile duct injury imaging findings can help interventional radiologists in providing correct diagnosis and treatment. Awareness of patients with high-risk factors may also reduce post-TACE ischemic biliary injuries.