E4781. Vascular Complications of Nonvascular Percutaneous Interventional Radiology Abdominal Procedures
  1. Easton Neitzel; University of Arizona College of Medicine - Phoenix
  2. Jack Stearns; University of Arizona College of Medicine - Phoenix
  3. Luke Lammers; University of Arizona College of Medicine - Phoenix; University of California, Santa Barbara
  4. Eric vanSonnenberg; University of Arizona College of Medicine - Phoenix
Nonvascular abdominal procedures constitute a wide breadth of interventional radiology (IR) and are in increasing demand. Nonvascular procedures include, although are not limited to, percutaneous abscess and fluid collection drainage, percutaneous biliary drainage, percutaneous nephrostomy, percutaneous radiofrequency, microwave, and cryotherapy tumor ablation, and celiac plexus neurolysis. Despite being minimally invasive and offering many advantages over traditional, open surgeries, these procedures are not without risk. Vascular injuries, such as hemorrhage, pseudoaneurysm, and/or dissection may occur, and may be life-threatening. The purpose of this review is to compile and present the reported vascular complications in the literature that have resulted from these procedures.

Materials and Methods:
A literature review was conducted using the PubMed database to catalog relevant articles published in 2000 or later, in which an iatrogenic vascular complication from a nonvascular percutaneous IR abdominal procedure was reported. PubMed database was utilized by searching the procedure name and the following MeSH term combinations: “vascular complications” AND “interventional radiology.” The following variables were recorded for each complication: patient age and sex, procedure performed, indication for procedure, vascular complication, and preoperative coagulation status. A total of 55 studies (36 case reports, 19 cohort studies) were included in our analysis.

Eight vascular complications resulted from percutaneous fluid collection drainage in the literature. Eleven vascular complications, most commonly hepatic artery pseudoaneurysm (7/11, 64%), resulted from percutaneous biliary drainage in case reports. Cohort studies indicate vascular compilations occur in 2.3% (133/5729) of percutaneous biliary drainage procedures. Eighteen vascular complications from percutaneous nephrostomy procedures have been reported, the most common being renal vein puncture (14/18, 78%), with 8/18 (44%) further complicated by extension into the IVC. Among case reports of percutaneous renal and liver tumor ablation procedures, 13 patients had vascular complications, including 10/13 (77%) pseudoaneurysms. Cohort studies of percutaneous ablation of renal and hepatic tumors indicate a vascular complication rate of 1.8% (223/12,302). Two reported vascular complications from celiac plexus neurolysis were reported, one by superior mesenteric vein thrombosis, the other resulted in death following perforation of the aorta. Preoperative coagulation status was only mentioned in 15/55 (27%) of articles.

Despite nonvascular percutaneous IR abdominal procedures being minimally invasive, vascular complications have occurred. Through the presentation of vascular complications associated with these procedures, awareness of these complications can inform interventionalists, hopefully decreasing the likelihood of these complications.