Large bore transhepatic tract dilatation in pigs: Results and implications for human procedures

Abstract

SummaryLarge bore transhepatic tracts were created in six anesthetised pigs. A peripheral tract (entering the gall-bladder bed) and a central tract were created in each pig. After balloon dilatation to 30 F and passage of a 30 F inner diameter sheath, bleeding was monitored with the sheath in place and after sheath removal. Blood loss was quantified and tracts were examined microscopically. Peripheral tracts were shorter than central tracts (mean 1.9 versus 3.6 cm). Bleeding occurred more frequently and to a greater degree from central tracts. Injury to small arteries and veins was identified microscopically in two tracts that bled heavily. Although significant bleeding, or lack thereof after dilatation of large transhepatic tracts, was variable, recommendations for large tract dilatation include: selection of a peripheral tract route, use of a working sheath with an outside diameter not exceeding that of the inflated balloon, particular care to avoid loss of access and not removing sheaths prematurely.