Biliary Intervention for Disorders of the Liver

There are a number of problems in the liver that can be treated with non-surgical, interventional radiology techniques.

Following is a description of the some of the procedures RCT physicians perform, along with images that show the dramatic results produced using these techniques.
 

Image of the bile ducts, following the injection of x-ray dye,  showing a large gallstone trapped in the duct. This stone blocked the flow of bile through the duct, causing pain and jaundice. The same duct, following removal of the stone through the drainage catheter.

Percutaneous Transhepatic Cholangiogram (PTC) This procedure is performed by inserting a small needle between the ribs and into the liver. X-ray dye is then injected into the bile ducts to make them visible on x-ray, demonstrating the site of obstruction of the duct. This exam is used to evaluate the cause of jaundice, which can often be caused by a blockage in the duct that drains bile from the liver to the intestine. A PTC is most often done as the initial step in the placement of a catheter to drain the bile, relieving the obstructive jaundice without surgery. Biliary Drainage Catheter Placement Following the initial injection of contrast (x-ray dye) into the bile duct during a PTC, the interventional radiologist next guides a small guide wire through the needle, into the ducts and across the site of blockage while watching the wire and ducts on x-ray. Over this wire, a small tube (catheter) is then inserted to allow the bile to be drained from the liver, relieving the jaundice caused by blockage of the duct. Transjugular Intrahepatic Porto-systemic Shunt (TIPS)     Interventional radiologists perform this procedure to treat a condition called portal hypertension, which arises from the presence of cirrhosis of the liver. This procedure has been a major improvement over the surgical treatment of this condition, which carries a high risk of death in the period immediately after the operation. The interventional radiologist threads a thin tube (catheter) through a small incision in the neck and guides it to the blood vessels in the liver. Under x-ray guidance, the doctor creates a tunnel in the liver, using a stent, through which blood can flow from the portal vein through the liver.

Conditions for which biliary intervention is commonly used.   Bile Duct Obstruction In some patients, such as those with liver or pancreatic cancer, or individuals who have had an injury to the liver, the bile ducts become blocked and bile cannot drain from the liver. The interventional radiologist places a thin tube (catheter) through the skin and into the bile ducts to drain the bile. In some cases, a small metal cylinder, called a stent, is placed in the liver to hold the blocked area open. A catheter may also be placed to drain bile for patients who have a stone lodged in the bile ducts or as preparation for surgery on the bile ducts.       Portal Hypertension Seen most frequently in patients with liver disease such as cirrhosis or hepatitis, portal hypertension is a condition in which scarring in the liver creates a blockage to the flow of blood through the liver. The main vein to the liver is the portal vein. Because of this blockage, the pressure in the portal vein becomes very high, causing adjacent veins in the abdomen to become over dilated. In turn, these dilated veins (varices) rupture and cause life-threatening internal bleeding. By lowering the pressure in the portal vein, the risk of hemorrhage is greatly reduced.

An image of the  portal vein prior to a TIPS procedure. Cirrhosis caused elevated pressures in the portal vein and bleeding from dilated veins around the esophagus, called varices.   Following a TIPS procedure, blood flow through the liver is now seen in the shunt. This lowers the pressure in the varices, and allows them to shrink and prevent further bleeding.