Seminars in Interventional Radiology, Table of Contents Semin intervent Radiol 2021; 38(04): 488-491DOI: 10.1055/s-0041-1735605 Review Article Biliary-Caval Fistula following Y90 Radioembolization Authors Author Affiliations Alexander D. Hall 1 Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin Sarah B. White 1 Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin William S. Rilling 1 Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin Recommend Article Abstract Buy Article(opens in new window) Abstract The safety of radioembolization with yttrium-90 (90Y) is well documented and major complications are rare. Previous studies have demonstrated that biliary complications following 90Y, including bile duct injury and hepatic abscess formation, occur at an increased rate in patients who have had prior biliary surgery and interventions. This article reviews a case of a patient who developed recurrent cholangitis and sepsis as well as a biliary-caval fistula following radioembolization. Additionally, we review current data regarding biliary complications following radioembolization in patients with prior biliary intervention. Keywords Keywordsradioembolization - 90Y - liver-directed therapy - cholangitis - biliary infection - interventional radiology Full Text References References 1 Covey AM, Hussain SM. Liver-directed therapy for hepatocellular carcinoma: An overview of techniques, outcomes, and posttreatment imaging findings. AJR Am J Roentgenol 2017; 209 (01) 67-76 2 Mahnken AH. Current status of transarterial radioembolization. World J Radiol 2016; 8 (05) 449-459 3 Salem R, Lewandowski RJ, Mulcahy MF. et al. Radioembolization for hepatocellular carcinoma using yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology 2010; 138 (01) 52-64 4 Gray B, Van Hazel G, Hope M. et al. Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 2001; 12 (12) 1711-1720 5 Rhee TK, Lewandowski RJ, Liu DM. et al. 90Y radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg 2008; 247 (06) 1029-1035 6 Kennedy AS, Dezarn WA, McNeillie P. et al. Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol 2008; 31 (03) 271-279 7 Kennedy AS, Coldwell D, Nutting C. et al. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 2006; 65 (02) 412-425 8 Murthy R, Xiong H, Nunez R. et al. Yttrium 90 resin microspheres for the treatment of unresectable colorectal hepatic metastases after failure of multiple chemotherapy regimens: preliminary results. J Vasc Interv Radiol 2005; 16 (07) 937-945 9 Riaz A, Lewandowski RJ, Kulik LM. et al. Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 2009; 20 (09) 1121-1130 , quiz 1131 10 Riaz A, Awais R, Salem R. Side effects of yttrium-90 radioembolization. Front Oncol 2014; 4: 198 11 Atassi B, Bangash AK, Lewandowski RJ. et al. Biliary sequelae following radioembolization with yttrium-90 microspheres. J Vasc Interv Radiol 2008; 19 (05) 691-697 12 Salem R, Lewandowski RJ, Atassi B. et al. Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival. J Vasc Interv Radiol 2005; 16 (12) 1627-1639 13 Yu JS, Kim KW, Jeong MG, Lee DH, Park MS, Yoon SW. Predisposing factors of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic malignancy. Cardiovasc Intervent Radiol 2002; 25 (04) 270-274 14 Woo S, Chung JW, Hur S. et al. Liver abscess after transarterial chemoembolization in patients with bilioenteric anastomosis: frequency and risk factors. AJR Am J Roentgenol 2013; 200 (06) 1370-1377 15 Kim W, Clark TW, Baum RA, Soulen MC. Risk factors for liver abscess formation after hepatic chemoembolization. J Vasc Interv Radiol 2001; 12 (08) 965-968 16 Song SY, Chung JW, Han JK. et al. Liver abscess after transcatheter oily chemoembolization for hepatic tumors: incidence, predisposing factors, and clinical outcome. J Vasc Interv Radiol 2001; 12 (03) 313-320 17 Sun Z, Li G, Ai X. et al. Hepatic and biliary damage after transarterial chemoembolization for malignant hepatic tumors: incidence, diagnosis, treatment, outcome and mechanism. Crit Rev Oncol Hematol 2011; 79 (02) 164-174 18 Zhang B, Guo Y, Wu K, Shan H. Intrahepatic biloma following transcatheter arterial chemoembolization for hepatocellular carcinoma: incidence, imaging features and management. Mol Clin Oncol 2017; 6 (06) 937-943 19 Sivaraj SM, Vimalraj V, Saravanaboopathy P. et al. Is bactibilia a predictor of poor outcome of pancreaticoduodenectomy?. Hepatobiliary Pancreat Dis Int 2010; 9 (01) 65-68 20 Cholapranee A, van Houten D, Deitrick G. et al. Risk of liver abscess formation in patients with prior biliary intervention following yttrium-90 radioembolization. Cardiovasc Intervent Radiol 2015; 38 (02) 397-400 21 Parikh RS, Abousoud O, Hunt S. et al. Infection rates following hepatic embolotherapy in patients with prior biliary interventions: comparison of single-drug moxifloxacin and multidrug antibiotic prophylaxis. J Vasc Interv Radiol 2021; 32 (05) 739-744 22 Devulapalli KK, Fidelman N, Soulen MC. et al. 90Y radioembolization for hepatic malignancy in patients with previous biliary intervention: multicenter analysis of hepatobiliary infections. Radiology 2018; 288 (03) 774-781 23 Mascarenhas NB, Mulcahy MF, Lewandowski RJ, Salem R, Ryu RK. Hepatic abscess after yttrium-90 radioembolization for islet-cell tumor hepatic metastasis. Cardiovasc Intervent Radiol 2010; 33 (03) 650-653 24 Mascarenhas N, Ryu RK, Salem R. Hepatic radioembolization complicated by abscess. Semin Intervent Radiol 2011; 28 (02) 222-225 25 Fatemi N, Lee A, Kessler J, Park J. Evaluating the safety of radioembolization with yttrium 90 microspheres in patients with prior biliary intervention. J Vasc Interv Radiol 2017; 28 (02) S216-S217 26 Geschwind JF, Kaushik S, Ramsey DE, Choti MA, Fishman EK, Kobeiter H. Influence of a new prophylactic antibiotic therapy on the incidence of liver abscesses after chemoembolization treatment of liver tumors. J Vasc Interv Radiol 2002; 13 (11) 1163-1166