PMC6320348_01
Initial cholangiogram during left IEBD catheter placement. The CBD stent (long arrow) is obstructed (a). There was no isolation of ducts (b). The proximal duodenal stent (short arrow) and catheter of HAIP (arrowhead) are evident
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Fig1
Cholangiography confirmed obstruction of the CBD stent and an internal-external biliary drainage (IEBD) catheter was placed via a segment 3 duct (Fig. 1).
Hepatic arteriography shows (a and b) obstructed common hepatic artery (long arrow) and segment 2 and 3 hepatic arteries (short arrows) recanalized through small tortuous collaterals (asterisk) via left gastric artery. Selective arteriogram via a collateral vessel from the left gastric artery (b). Hepatic arteriography beyond obstructed common hepatic artery only shows a segmental right hepatic artery branch (c)
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Fig2
Retrograde cannulation of the left hepatic artery via the collaterals was not possible (Fig. 2). The left hepatic artery could not be cannulated antegradely or retrogradely (Fig. 2).
Sheath cholangiogram (a) shows lateral segment hepatic artery branches (short arrows). The segment 3 artery is cannulated both distal (b) and proximal (c) to the arteriobiliary fistula for coil embolization. Final sheath cholangiogram (d) shows resolution of flow in lateral segment arteries from the segment 3 bile duct
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Fig3
Final sheath cholangiography showed no flow in the embolized artery (Fig. 3).