Hybrid intervention with angio-CT for percutaneous transhepatic biliary drainage (PTBD)

Abstract Purpose To evaluate a hybrid angiography-CT (angio-CT) system for percutaneous transhepatic biliary drainage (PTBD) in patients with biliodigestive anastomosis, aerobilia, and the need for external biliary drainage. Materials and methods Ten patients with bile duct leakage and aerobilia underwent angio-CT-guided PTBD. The angio-CT enabled combined CT and fluoroscopic imaging in a single procedural setting. Aerobilia facilitated bile duct visualization, particularly in left-sided ducts. Key steps included CT-guided puncture, fluoroscopic catheter placement, and integration of both modalities to streamline workflow. Results Successful biliary access and drainage were achieved in all cases. The combined imaging approach allowed for short intervention times (mean: 25 min) and ensured safety without complications. Aerobilia, improved visualization and precision were key contributors to the technique’s success. Conclusion Angio-CT may improve procedural precision and safety when aerobilia is present.The integration of CT and angiography within a single system offers a reliable solution for challenging biliary interventions. Larger studies are needed to confirm these findings.