Biliary Intervention for Disorders of
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
of x-ray dye,
showing a large
in the duct.
flow of bile
through the duct,
The same duct,
of the stone
Percutaneous Transhepatic Cholangiogram
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
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
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
portal vein and
Following a TIPS
liver is now
in the shunt.
This lowers the
pressure in the
them to shrink
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