E2547. IR Techniques for Biliary Neo-Anastomosis Creation in Biliary Occlusion: Patient Selection, Techniques, and Review of Reported Outcomes
  1. Eric Bready; University of Alabama at Birmingham
  2. Hussamedin El Khudari; University of Alabama at Birmingham
  3. Junjian Huang; University of Alabama at Birmingham
  4. Andrew Gunn; University of Alabama at Birmingham
Bile duct injury is an important consideration for patients undergoing invasive liver interventions, such as liver transplantation or hepatic resection. Partial hepatectomy, especially, can rarely result in biliary occlusion where a portion of the biliary tree which can no longer drain into the enteric system. Interventional radiologists play a key role in the management of this complex biliary complication, including short-term biliary drain placement, but also creation of biliary neo-anastomoses as a long-term, durable solution. Using simple instruments, fluoroscopy, and sometimes collaboration with other specialties, interventional radiologists can safely create new connections from occluded bile ducts to allow enteric drainage of bile, thereby helping patients avoid additional invasive surgery.

Educational Goals / Teaching Points
Illustrate normal bile duct anatomy and postsurgical bile duct anatomy. Highlight biliary injury classification systems. Review patient presentation and imaging diagnosis of bile duct injury. Illustrate tools and techniques used for biliary access in preparation for biliary neo-anastomosis creation, including RF wires and sharp recanalization. Discuss post-neo-anastomosis management using either internal/external biliary drain or internal metallic biliary stent.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Normal and variant biliary duct anatomy. Classification of bile duct injury. Imaging diagnosis of a bile duct injury or leak. Imaging and instruments used in sharp recanalization. Rendezvous technique in collaboration with gastroenterology. Post-neo-anastomosis management.

Biliary duct injuries, such as total biliary occlusion, are a rare complication of hepatic surgical procedures. Interventional radiologists have a unique skillset to temporize and treat bile duct occlusion, including the creation of biliary neo-anastomoses.